A pain in the shoulder region is a common musculoskeletal condition. When it is of no specific cause, it is often given the general diagnostic term of rotator cuff related shoulder pain (RCRSP). Simply, it is an umbrella term that can encompass a spectrum of shoulder conditions including tendinopathies, impingement syndromes and rotator cuff muscles tears.
RCRSP are the most common forms of should pain, often presenting with pain and weakness, particularly on shoulder elevation and external rotation (turning the hand to an outwards direction).
Most often, pain is precipitated by an event that has involved an excess or incorrect load. Many factors can also contribute including genetics, co-morbidities, lifestyle factors, central nervous system disturbances, psychosocial and even biochemical factors.
The difficulty with assessing the shoulder lies in the fact that the tendons of the rotator cuff sling create an intimate relationship with the surrounding capsule, ligament and bursal tissue. Due to this fact, the possibility of individually assessing each muscle/tendon complex in isolation through orthopaedic testing is not 100% accurate. A comprehensive clinical interview and examination is still however very important in providing a working hypothesis.
Rotator cuff injury Treatment & Exercise
How Do I Get Better – the evidence
There is strong evidence for the benefits of multiple forms of exercise as the most important management strategy. Included are such things as shoulder blade stability, strengthening of the rotator cuff muscles and shoulder flexibility. There is moderate to high level of evidence for the combination of manual therapy with exercise.
There appears to be limited benefits in corticosteroid injections for rotator cuff injuries, potentially only for short term benefits for some and the evidence for medium or long term use is unclear.
PRP or Platelet-rich plasma is also another form of injectable therapy however researchers concluded it had negligible to only a small degree of success. These findings are not surprising as it is well documented that pain is often poorly correlated with tissue pathology. A lot more research into surgical repair is required including methodology improvements and placebo controls as at present there is not a great support for a non-conservative procedure.
Manual Therapy for rotator cuff injury – from our Sydney chiropractic clinic experience alone, we have found that many shoulder injuries come from the sustained loading of the shoulder muscles due to poor postural control. Compression at the collar bond joint through rounded shoulders is common. The shoulder blades essentially drift outwards away from the thoracic spine causing the muscles under the shoulder blade to overload as well as all the important sling muscles of the shoulder joint. Micro-tears can then become a common feature. Also, through poor postural control, restrictions in the thoracic spine are common. In some cases, the nerve supply to these important muscles can then become compromised and a lack of ‘firing’ is possible causing significant weakness. Manual therapy and specific muscle retraining exercises are then often required. Postural control exercises are therefore very important to implement regularly, Taping is a useful technique for support, relief as well as acting as a reminder.
Immerging Therapy For Rotator Cuff Injury
We have found that low level laser (LLLT) for healing is helpful. More research is required in this immerging field. The theory behind implementing low level laser is that it stimulates energy within the cell. When energy is increased, healing can fasten. One of the most commonly damaged muscles is called the supraspinatus. In many people, the blood supply to this muscle is very poor and it needs all the help it can get for recovery. With the use of the photohaemotherapy application (increasing the blood supply) in LLLT to this muscle this procedure could be potentially significant in the recovery.
In summary, for many people shoulder pain can come on suddenly from what can appear an insignificant event. Consider your posture and consider a Chiropractor for shoulder pain to improve neuromuscular control.