Rotator Cuff Related Pain
What is Rotator Cuff Related Pain?
Rotator cuff related shoulder pain occurs when muscles, tendons or bursa are irritated within the shoulder joint on certain movements, which can lead to pain, stiffness and restricted movement. This can be due to overuse (especially with overhead work), weakness of the muscles in the shoulder, or sometimes occurs after minor trauma. Often there is no apparent cause for the pain and it may come on suddenly or gradually.
The Shoulder Joint
There are 3 bones which make up the shoulder complex including the humerus (upper arm bone), clavicle (collar bone) and the scapula (shoulder blade). The three bones in the shoulder region form part of two main joints:
- The gleno-humeral joint between the glenoid of the scapula and the humerus.
- The acromioclavicular joint between the acromion of the scapula and the clavicle.
There are also a number of muscles, ligaments and tendons around the shoulder. Ligaments are fibres that link bones together at a joint. Tendons are fibres that attach muscle to bone.
The Rotator Cuff
What is the rotator cuff?
The rotator cuff is a group of four muscles that are positioned around the shoulder joint. The muscles are named:
- Supraspinatus
- Infraspinatus
- Subscapularis
- Teres minor
The rotator cuff muscles work as a unit. They help to stabilise the shoulder joint and also help with shoulder joint movement. The four tendons of the rotator cuff muscles join together to form one larger tendon, called the rotator cuff tendon. This tendon attaches to the head of the humerus (the bony surface at the top of the upper arm bone). There is a space underneath the acromion of the scapula, called the subacromial space. The rotator cuff tendon passes through here. When the rotator cuff muscles don’t work as they should it can cause pain.
What are the symptoms of rotator cuff related shoulder pain?
Symptoms vary from person to person but may include;
- Pain in the shoulder and upper arm. This may radiate down the arm in more severe cases. It can present as either an ache or a sharp pain, or a combination of the two.
- Pain on activities such as lifting, reaching, overhead movements or driving.
- Pain when lying on the shoulder.
- Pain may be worse at night time and can affect your sleep.
- There may be some mild weakness of the shoulder muscles making it harder to lift your arm.
How is rotator cuff related shoulder pain diagnosed?
Rotator cuff related shoulder pain can be diagnosed after taking a history and undertaking a physical examination with your physiotherapist. It is a broad diagnosis which can be affected by various structures in the shoulder. Rotator cuff related shoulder pain usually presents as pain in your shoulder and upper arm. In some cases it can refer further down your arm and up towards your neck. Classically people with Rotator cuff related shoulder pain complain of pain when moving the arm such as reaching and with twisting activities, such as putting your hand behind your back or putting a coat on. People also often present with what is called a painful arc, where the shoulder is more painful with your arm in specific ranges of your movement. You may also experience discomfort when lying on your affected shoulder, pain when reaching across your body and sometimes you may also experience a sensation of locking with certain movements. Depending on the irritability of your symptoms some people may experience pain at night and pain when your arm is resting. This is more often the case when more inflammation is present.
Do I need any other investigations?
Imaging can be helpful following trauma to diagnose fractures or following dislocation of the shoulder. Further investigations are rarely needed for non - traumatic shoulder pain.
Structural changes on investigations such as tendon tears or bursal changes (thickening/bursitis) is just as common in people with no shoulder pain as it is in people with shoulder pain. In fact in one study, up to 96% of people with no shoulder pain and no loss of function were found to have structural changes, such as tears, bursal thickening and many other changes. This means that what is seen on investigations is usually not the cause of the problem and in most cases the findings cannot tell you where the pain is coming from. Most scan findings relate more to your age rather than any pain you may have.
Getting better usually has nothing to do with ‘fixing’ what was found on these investigations, and in most situations, you should not worry about what any imaging has found.
How long will it take to get better?
This will depend on the severity of your symptoms and it may take up to a few months to improve. It is vital to make sure the muscles around the shoulder are working well and this is usually achieved through an individual exercise program. Your shoulder should start to feel better within 6 to 12 weeks if you follow our guided exercise program. By following these exercises we will guide you through each step on your return to normal activity.
What can I do to help myself?
Be positive and keep moving! There are many things you can do yourself to help manage your symptoms. There are no quick fixes and it requires active participation from you throughout to achieve your desired goals.
The Exercises
Participating in an exercise program carries a certain element of risk for some people. You should consult with your physiotherapist before initiating this program to ensure your safety.
If you have any issues please do not hesitate to contact the physiotherapy department. If you feel light headed, dizzy or have issues with your breathing please contact your general practitioner (GP) immediately.
When carrying out this exercise program you may feel some discomfort at your Shoulder. It is important that this pain does not exceed 3/10, where 10/10 is the maximal and 0/10 is no pain.
Level one
| Repetitions | 15 - 25 |
| Number of Sets | 3 |
| Rest Period Between Sets | 30 seconds – 1 minute |
| Times Per Day | 2 |
*Unless otherwise stated
- Table slides.
In a sitting position place your hand/hands on a table on top of a table cloth (anything to reduce friction). Slowly lean forwards allowing your arms to move forwards freely, using pain as your guide for the limit of movement. Return to starting position. You can do this taking your arm out to the side or rotating arm out and in.Flexionhttps://www.youtube.com/watch?v=PXKQM6wUv98Abductionhttps://www.youtube.com/watch?v=OQhcDcnucDARotationhttps://www.youtube.com/watch?v=OpCKdTy9ts4
- Isometric abduction/ lateral rotation (rotator cuff initiation).
2a. Abduction: In Standing with your elbow resting against a wall, push your elbow into the wall at approximately 20 – 30% of your maximal effort.Hold 10 - 45 seconds, complete 3 – 5 sets.https://www.youtube.com/watch?v=KGhMJfA8DAU2b. Lateral rotation: in standing with your hand resting against a wall, push your hand against the wall at approximately 20 – 30% of your maximal effort.Hold 10 - 45 seconds, complete 3 – 5 sets.https://www.youtube.com/watch?v=Taos8JNGSXE
- Wall Press – ups
Face a wall, standing a little farther than arm’s length away, feet shoulder-width apart. Lean your body forward and put your palms flat against the wall at shoulder height and shoulder-width apart. Slowly breathe in as you bend your elbows and lower your upper body toward the wall in a slow, controlled motion. Breathe out as you return to the starting position
https://www.youtube.com/watch?v=vE2N9B7eYi0
- Scapula setting/adduction
In standing or sitting, move your shoulder blades gently back and downwards, feeling the muscles between your shoulder blades working.
Hold 10 -45 seconds, complete 3 – 5 sets.
https://www.youtube.com/watch?v=9WAaLhBR2Lo
Level Two
| Repetitions | 15 - 25 |
| Number of Sets | 3 |
| Rest Period Between Sets | 30 seconds – 1 minute |
| Times Per Day | 2 |
*Unless otherwise stated
- Wall slides with cuff activation
In a standing position put a light resistance band around both hands or wrists applying tension outwards. Place your hands on the wall just below shoulder height, on top of a pillow case or towel (anything to reduce friction). Slide your hands up the wall using pain as your guide to limit the movement.
https://www.youtube.com/watch?v=qwvK0IH6BQw
- Lateral rotation in prone
Lying face down, rest your affected arm over the edge of the bed and place a pillow underneath your shoulder for support. Keeping your elbow in a bent position, slowly move your hand forwards, using pain as a guide for limiting range of movement. Return to start position.b. To progress, remove the pillow support from underneath your shoulder and hold a light weight (approx. 1-2kg) in your exercising arm.
https://www.youtube.com/watch?v=kuepIDr_MZ8 3. Table press – up
Face a table, standing a little farther than arm’s length away, feet shoulder-width apart. Lean your body forward and put your palms flat against the table at shoulder height and shoulder-width apart. Slowly breathe in as you bend your elbows and lower your upper body toward the table in a slow, controlled motion. Breathe out as you return to the starting position
https://www.youtube.com/watch?v=7a5cWNj9hpA
- Scapula setting/adduction with band
In standing, hold onto a light resistance band with your hands facing down and elbows locked out in a comfortable stance. Move your shoulder blades gently back and downwards, feeling the muscles between your shoulder blades working and apply more resistance by gently pulling out to the side.
Hold 10 -45 seconds, complete 3 – 5 sets.
https://www.youtube.com/watch?v=gAa518_oFX8
Level Three
| Repetitions | 15 - 25 |
| Number of Sets | 3 |
| Rest Period Between Sets | 30 seconds – 1 minute |
| Times Per Day | 2 |
*Unless otherwise stated
- Shoulder elevation with rotator cuff initiation
In a standing position put a light resistance band around both hands or wrists applying tension outwards. Elevate both arms above your head stepping forward with the opposite leg to the affects shoulder, maintaining tension on the band. Return to starting position. To progress this exercise you can step into a lunge.
https://www.youtube.com/watch?v=Ix7hcjH33Cg
- Lawn mower
Begin with your feet hip width apart and your non affected side foot a few inches behind the other. Step on to a resistance band with the other foot and grab the band with the affected shoulder hand. Bend your knees, rotate your torso to the non affected side and bring the affected side hand towards the foot the band is under. Stand up, rotate your torso slightly to the affected side and pull the band until close to your shoulder, as if trying to start a lawn mower. Return to starting position.
https://www.youtube.com/watch?v=nUGcvonp8mI
- Press- ups
Place your hands shoulder-width apart with arms straight and so your shoulders, elbows and wrists line up. With your knees on the floor, keep a straight line from your knees to your shoulders. Initiate the move by bending your elbows to lower your chest towards the ground. The closer you can get your chest to the floor the better because this makes the working muscles move through a full range of motion. Return to starting position
https://www.youtube.com/watch?v=9Boev1O_i7E
- Bent over Row.
Stand with legs about shoulder-width apart, with knees soft or slightly bent. Hold a dumbbell in each hand, palms facing the body, holding them shoulder-width apart.
With a dumbbell in each hand, bend over at about a 45-degree angle (no farther). Keep the back straight throughout the exercise. Brace your abdominals and breathe in. Lift the weights straight up, exhaling. While lifting, the arms should go no higher than parallel with the shoulders—slightly lower than the shoulders is fine. While lifting, try to keep the wrists from excessive extra movement down or to the side. Do not squat down and up after the initial pose. No movement of the legs occurs throughout the exercise. Lower the weights in a controlled manner while inhaling. Remain bent over until all repetitions are complete.
https://www.youtube.com/watch?v=ssd2aCQgud8https://www.youtube.com/watch?v=k1rrbCdUpQM