December brings a new instalment of the Orchard Clinic blog, but as well as wishing everyone warm wishes this Christmas we are going to take this opportunity to discuss Rotator Cuff Related Shoulder Pain (RCRSP). Shoulder pain is fast becoming one of the most prevalent conditions seen within physiotherapy and is the 3rd most common condition that patients seek advice and treatment from their GP for. There are multiple causes for shoulder pain however, we are going to discuss a spectrum of disorders which are more appropriately called rotator cuff related shoulder pain – this term fits more appropriately with current understanding and evidence as previously commonly called subacromial bursitis, shoulder impingement syndrome, partial or full thickness tears and rotator cuff tendinopathy.
The shoulder is the most mobile joint in the body, because it has so much mobility it requires a lot of muscle control to maintain stability around the joint. The glenohumeral joint is one joint which make up the shoulder complex – this is comprised of the humerus and the glenoid, the humerus sits within the glenoid fossa which is referred to as a ball and socket joint. The main stabiliser muscles around the shoulder are the rotator cuff muscles. The rotator cuff is made of four muscles – supraspinatus, infraspinatus, Teres minor and subscapularis. Their role is to help keep the humerus in the centre of the joint
The subacromial bursa is a fluid filled sack designed to reduce friction over the tendons and sits between the humerus and part of the scapular (shoulder blade) called the acromion. Irritation of the bursa is often stated as a cause of shoulder pain however there is generally an underlying reason as to why the bursa is irritated and in some instances this may be a normal adaptation.
RCRSP as a term identifies that it is not only the local structures that could be causing symptoms, however identifies that multiple factors can contribute to symptoms.
Presentation and Factors influencing RCRSP
RCRSP may present with altered shoulder function and movement with pain on lifting the arm (flexion), rotating the arm out to the side (lateral rotation) or placing your hand behind the back. Pain may quickly be experienced if the shoulder has been used for an activity that is more demanding than it is generally used for on a day to day basis or slowly overtime. RCRSP can present where it is really irritable, coming and going over a period of time and non-irritable or more advanced. There are numerous factors that can influence the presence of symptoms such as hormonal factors, lifestyle factors such as smoking, alcohol consumption, reduced level of general exercise and increased weight. Altered biomechanics and excessive loading or maladaptive loading on the tissues such as the rotator cuff have the potential to contribute to RCRSP. Altered loading can be as a result of weakness in the rotator cuff muscles, the deltoid muscles, the scapulothoracic muscles or over activity in other muscle groups around the shoulder girdle.
Developments in research has challenged the concepts of how the rotator cuff muscles work as not only stabilisers but also as movers of the humeral head within the joint. This has led to informed and tailored exercise prescriptions. Graduated and well-constructed exercise programme have been considered at equivalent benefits as that of surgery – such as subacromial decompression surgery or rotator cuff repair surgery especially in the absence of any trauma.
At the Orchard Clinic we will ask a you a series of questions to understand you and your symptoms and thoroughly assess you to help diagnose the source of your shoulder pain and symptoms.
Physiotherapy aims to thoroughly assess and address any identified contributing factors leading to RCRSP. However there is still on-going debate regarding the cause as this will be individual to each person. As aforementioned RCRSP encompasses patients that have partial or full thickness rotator cuff tears, in some studies it is reported that 54% of people over the age of 60 years without shoulder symptoms demonstrated these changes on MRI. This principle will be discussed in further upcoming blogs.
At the Orchard Clinic we pride ourselves on an individual approach to care, putting you as the patient in the centre of the treatment of you shoulder pain. This allows us to work with you to identify any potential causes to symptoms and your individual needs.
Wishing you all a Merry Christmas and a happy and healthy New Year!
If you require physiotherapy assistance, please contact Reception on 01727 855 414 to book an appointment.