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Shoulder injuries

The shoulder is a relatively unstable joint with lots of movement “choices” Learn more about the shoulder joint and its anatomy HERE. These movements are produced and controlled by the four muscles that make up the rotator cuff. These four muscles are the Subscapularis, Supraspinatus, Infraspinatus, and the teres minor.

As the name suggests, the rotator cuff is a muscular cuff around the head of the humerus that is responsible for shoulder rotation.


What Rotator Cuff Injuries are Common?


The muscles and tendons are vulnerable to rotator cuff tears, rotator cuff tendonitis, rotator cuff impingement, and related rotator cuff injuries.

Rotator cuff injuries can vary from mild tendon inflammation ( rotator cuff tendonitis), shoulder bursitis (inflamed bursa), calcific tendonitis (bone/calcification forming within the rotator cuff tendon) through to partial and full-thickness rotator cuff tears, which may require rotator cuff surgery.


Some shoulder rotator cuff injuries are more common than others.

These include:

  • Rotator Cuff Impingement

  • Rotator Cuff Tendonitis

  • Shoulder Bursitis (a fluid-filled sac that provides a cushion between a bone and tissues)

  • Calcific Tendonitis

  • Rotator Cuff Tears


Where are your Rotator Cuff Muscles?


Your rotator cuff muscles hold your arm (humerus) onto your shoulder blade (scapula) like a cuff. Most of the rotator cuff tendons are protected under the bony point of your shoulder (acromion), which as well as protecting your rotator cuff can also impinge on your rotator cuff structures.


What Causes a Rotator Cuff Injury?


As stated above, your rotator cuff tendons are protected from simple knocks and bumps by bones (mainly the acromion) and ligaments that form a protective arch over the top of your shoulder. In between the rotator cuff tendons and the bony arch is the bursa (a lubricating sack), which helps to protect the tendons from touching the bone and provide a smooth surface for the tendons to glide over. However, any of these structures can be injured - whether it be your bones, muscles, tendons, ligaments or bursas.

Rotator cuff impingement syndrome is a condition where your rotator cuff tendons are intermittently trapped and compressed during shoulder movements. This causes injury to the shoulder tendons and bursa resulting in painful shoulder movements.


What are the Symptoms of Rotator Cuff Injury?


While each specific rotator cuff injury has its own specific symptoms and signs, you should contact your doctor or PT about a suspected rotator cuff injury if you have:

an arc of shoulder pain or clicking when your arm is at shoulder height or when your arm is overhead.

  • shoulder pain that can extend from the top of your shoulder to your elbow.

  • shoulder pain when lying on your sore shoulder.

  • shoulder pain at rest (with more severe rotator cuff injuries).

  • shoulder muscle weakness or pain when attempting to reach or lift.

  • shoulder pain when putting your hand behind your back or head.

  • shoulder pain reaching for a seat-belt.


How is a Rotator Cuff Injury Diagnosed?


A diagnostic ultrasound scan is the most accurate method to diagnose the specific rotator cuff injury pathology. MRI’s may show a rotator cuff injury but have also been known to miss them. X-rays are of little diagnostic value when a rotator cuff injury is suspected.


How to Treat a Rotator Cuff Injury?


Once you suspect a rotator cuff injury, it is important to confirm the exact type of your rotator cuff injury since treatment does vary depending on the specific or combination of rotator cuff injuries.


As stated above, your rotator cuff is an important group of stability muscles that maintain the “centralization” of your shoulder joint. In other words, it keeps the shoulder ball, humerus, centered over the small socket. This prevents injuries such as impingement, subluxations, and dislocations.


We also know that your rotator cuff provides subtle gliding and sliding off the ball joint on the socket to allow full shoulder movement. Plus, your shoulder blade (scapula) has a vital role as the main dynamically stable base plate that attaches your arm to your chest wall.

Researchers have concluded that there are essentially 7 stages that need to be covered to effectively rehabilitate rotator cuff injuries and prevent a recurrence.

These are:


  • Early Injury Protection: Pain Relief & Anti-inflammatory Tips

  • Regain Full Range of Motion

  • Restore Scapular Control

  • Restore Normal Neck-Scapulo-Thoracic-Shoulder Function

  • Restore Rotator Cuff Strength

  • Restore High Speed, Power, Proprioception & Agility

  • Return to Sport or Work


What is Shoulder Tendonitis?


Shoulder tendonitis (or tendinitis) is inflammation of the tendons of your shoulder's rotator cuff. Inflammation is normally present in the acute phase of a tendon injury and is a normal component of the natural tendon healing process.


What Causes Shoulder Tendonitis?


The most common cause of shoulder tendonitis is repeated microtrauma to the rotator cuff tendons rather than a specific one-off trauma.

Rotator Cuff Impingement, where your rotator cuff tendon impacts against the acromion bone, should not occur during normal shoulder function. However, when repeated shoulder impingement occurs, your rotator cuff tendon becomes inflamed and swollen via friction and compression.

Shoulder bursitis commonly occurs in combination with rotator cuff tendonitis or rotator cuff impingement.


What are the Symptoms of Shoulder Tendonitis?


Shoulder tendonitis commonly has the following symptoms:

Shoulder clicking and/or an arc of shoulder pain when your arm is about shoulder height.

Pain when lying on the sore shoulder or lifting with a straight arm.

Shoulder pain or clicking when you move your hand behind your back or head.

Shoulder and upper arm pain (potentially as far as your elbow).

As your shoulder tendonitis deteriorates, your shoulder pain may even be present at rest.


  • What is the treatment for Shoulder Tendonitis?

  • Shoulder tendonitis is treated in 7 stages.

  • Pain relief and Anti-inflammatory

  • Regain full range of motion

  • Restore scapular control

  • Restore normal Neck-Thoracic-Scapular-Shoulder Function

  • Restore rotator cuff strength and function

  • Restore high-speed, power, proprioception and agility

  • Return to work or sport!


Shoulder Bursitis


Shoulder bursitis means an inflamed shoulder bursa. Your bursa is a fluid-filled sac that helps to reduce friction in your shoulder spaces. You have several bursae within your shoulder. Your subacromial bursa is the most commonly inflamed of the shoulder bursa. Subacromial bursitis is a common cause of shoulder pain that is usually related to shoulder impingement of your bursa between your rotator cuff tendons and the acromion.


What Does Bursitis in the Shoulder Feel Like?


Shoulder bursitis commonly presents with the following symptoms:

Gradual onset of your shoulder symptoms over weeks or months.

  • Pain on the outside of your shoulder.

  • Pain may spread down your arm towards the elbow or wrist.

  • The pain made worse when lying on your affected shoulder.

  • The pain made worse when using your arm above your head.

  • Painful arc of movement – shoulder pain felt between 60 - 90° of the arm moving up and outwards.


When your arm is by your side there is minimal pain and above 90° relief of pain.

Shoulder pain with activities such as washing hair, reaching up to a high shelf in the cupboard.


What Causes Shoulder Bursitis?

Bursitis around the shoulder can be caused by a repeated minor trauma such as overuse of the shoulder joint and muscles or a single more significant trauma such as a fall. In overuse type injuries, bursitis is often associated with impingement and tendonitis (inflammation) of the rotator cuff tendons.


How Can You Prevent Shoulder Bursitis?


Eliminating the causes of primary and secondary impingement is the key to preventing shoulder bursitis and rotator cuff problems. Factors such as posture, muscle length, shoulder stability, and rotator cuff strength need to be addressed and can be optimized with specific exercises as prescribed by your Pilates Instructor or physiotherapist.


Rotator cuff tear


A rotator cuff tear is quite simply a tear within your shoulder’s rotator cuff tendons. A rotator cuff tear can occur in two ways:

  • Trauma

  • repeated microtrauma

Traumatic rotator cuff tears occur quickly or under heavy load eg) a fall or lifting a heavyweight. However, the most common cause of a rotator cuff tear is repeated microtrauma, which can occur over several weeks, months, or years.


Repeated rotator cuff injury from straining or pinching the rotator cuff tendons will injure the soft tissue resulting in bruising, and/or swelling. Since there are only a few millimeters separating your rotator cuff tendons from the acromion, the additional swelling causes a quicker impingement, catching or squeezing of the rotator cuff tendons.


What are the Symptoms of a Rotator Cuff Tear?


Your rotator cuff tears may be partial or full-thickness tears. You will notice that shoulder pain and weakness increases with the severity of the rotator cuff tear. More importantly, it’s a reduction in shoulder function that is important.

Partial rotator cuff tear may only show itself with mild shoulder pain, clicking during shoulder elevation and mild shoulder weakness lifting your hand above shoulder height or reaching behind your back.


Full-thickness rotator cuff tear will normally present with severe shoulder pain and an inability to lift your elbow away from your body. However, in some cases, the rotator cuff tear is so severe that a significant number of your pain fibers are also torn, which can make them less painful but very weak.


When you have a small rotator cuff tear you can often still raise your arm with or without pain. Moderate tears are usually very painful and you’ll have difficulty moving your arm. Most patients can’t sleep due to the relentless pain. When a large rotator cuff tear occurs you may find that you are unable to lift your arm at all.


Rotator Cuff Tear Treatment


Rotator cuff tears are a common problem. Rotator cuff injury deteriorates further if you return to sport or work too quickly – especially if a thorough rehabilitation program is not completed. They are also regularly poorly treated by inexperienced shoulder practitioners

Researchers have concluded that there are essentially 7 stages that need to be covered to effectively rehabilitate rotator cuff tears and prevent a recurrence.


These are:

  • Early Injury Protection: Pain Relief & Anti-inflammatory Tips

  • Regain Full Shoulder Range of Motion

  • Restore Scapular Control

  • Restore Normal Neck-Scapulo-Thoracic-Shoulder Function

  • Restore Rotator Cuff Strength

  • Restore High Speed, Power, Proprioception & Agility

  • Return to Sport or Work

Your Pilates instructor and your physiotherapist will discuss your goals, time frames and training schedules with you to optimize you for a complete return to sport or work.

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