Rotator Cuff Tendinopathy

This is the most common cause of shoulder pain. The rotator cuff (RC) is a group of four muscles which work together to keep the joint in optimal position throughout movement.

The 4 muscles are:

– Supraspinatus

– Infraspinatus

– Teres Minor

– Subscapularis

The shoulder is a shallow ball and socket joint and subsequently requires significant support from the rotator cuff muscles – among other structures like tendons and ligaments, to maintain stability.

Presentation is dependent on the affected tendon(s) however symptoms are usually made worse with certain positions of actions. Overhead movement, reaching behind the back – such as putting on your coat, lifting and sleeping on the symptomatic side can all cause pain. Symptoms tend to develop over a period of time – usually in which there has been a relative increase in exercise or activity that may or may not be related to overhead movements. It is not uncommon to see localised swelling and there is typically and associated reduction in strength and range of movement.

Rotator Cuff (RC) tendinopathies are often named with different terms such as tendinitis or impingement. RC tendinopathy is an overuse condition of the tendons of these muscles which can start showing signs of wear & tear as we age or can become painful if they are exposed to more load than they are used to.

Consequently, they can become sore and weak, meaning they offer less support to the shoulder joint. Sometimes this can lead to a mechanical impingement around the shoulder joint as the tendon doesn’t keep the top of the humerus (upper arm bone) centralised against the socket. This can lead to pain in the upper arm, particularly if using the arm away from the body, or lying on the affected side. Genetics are also believed to play a role in those who do/don’t develop these symptoms.

Our experienced Physiotherapists see and deal with this condition on a regular basis. The detailed verbal and physical assessment you will receive will allow us to identify and diagnose the underlying cause of your symptoms. Obtaining a definitive and timely diagnosis ensures that the most effective treatment and management plan is put in place for optimal recovery and a faster return to normal function and activity.

Your Physiotherapist will help you modify activities that cause symptom irritation whilst you build strength back up. This may just mean adjusting the way you move or lift or load, or maybe avoiding lying on the affected side. At Pure, we ensure that each patient is given education on their condition and how to best manage it to facilitate optimal recovery.

With skilled & personalised exercise prescription combined with manual therapy, our clinicians at Pure Physiotherapy can support your recovery and restoration of full shoulder function.

A key facet of the multi-modal approach we offer at Pure is a graded strengthening program aimed at improving the quality of the tendon & focusing on the activities important to you whilst taking your functional capabilities in to account.

Please find the patient resources section of our website where we have developed a set of exercise programmes specifically for this condition. We advise consulting with your Physiotherapist prior to trying any of these exercises.

It may take a few weeks or even a few months to notice a significant improvement in your symptoms, but it is important you persist with the exercises and the carefully chosen progressive loading plan. Your Physiotherapist at Pure will instruct you on how to perform the exercises, how many and how often. By re-assessing your symptoms and function, your clinician can ensure that your current treatment and management plan is helping to achieve your personal goals and that it remains highly effective. We value ongoing support and advice to help prevent re-occurrence.

Occasionally a patient may receive an injection into structures around the tendon to provide some pain relief. It is important to note that this will not correct the problem with the tendon, but it may provide a window of pain relief for you to then be able to complete your rehabilitation program with less discomfort. Click here for more information from the NHS on hydrocortisone injections.