Shoulder pain is the 3rd most common presentation in the physiotherapy clinic with about 50% of people having an episode of shoulder pain per year.
Rotator cuff related shoulder pain (RCRSP) is when one or more of the following muscles that make up the rotator cuff complex (supraspinatus, infraspinatus, teres minor, subscapularis) are compromised. Commonly presenting as a tendinopathy, partial or full thickness tear.
Where is pain experienced?
This pain is often described as a dull ache on the front and/or outside of the shoulder, but can be sharp with jolty movement. Pain is reproduced when laying on your affected side, taking the arm out to the side (abduction) and when you take the forearm away from the body, whilst keeping the elbow by your side (external rotation) or even taking your hands overhead. RCRSP, it is not normally coupled with neurological signs such as pins and needles and will not travel down past the elbow.
If you are under 40, tendinopathies/partial thickness tears are more common. If you are over 40, due to age-related degeneration, it is more likely a full thickness tear.
Do I need imaging?
So, we should get some shoulder imaging right? Well, imaging can be useful in cases where the injury is traumatic (such as a fall), presents with severe weakness, alterations in sensation, suspected fracture, dislocation, frozen shoulder or a sinister pathology when things don’t quite add up. However, because RCRSP typically does not present with above symptoms, it is not always warranted straight away. Imaging can even negatively affect one’s experience of pain as research on people with no shoulder pain still observed pathological findings on scans. This can create extra costs, stress and worry that you don’t need.
Do I need a steroid injection?
What about going to the GP to get a corticosteroid injection? What does the research suggest? Well, corticosteroids may be better than placebo and oral NSAIDs in the short term (6-8 weeks) for improving shoulder function. However, at 3 months, there seemed to be no superior effect when compared to physiotherapy. More research is even showing that corticosteroids can have negative affect on collagen and tendinous tissue which increases the risk of degeneration and future ruptures…
How physiotherapy can help
How about Physiotherapy and Exercise Therapy? Well the research is promising! Research suggests that progressive strengthening is effective and should be the first line of treatment for RCRSP. Although research doesn’t suggest massive increases in strength in shorter research trials, the improvements in symptoms are more likely related to an increased capacity of the tissue to tolerate loads.
Let’s sum up…
So if you are experiencing shoulder pain, instead of running straight for scans or injections, come down for a quick visit at Burleigh and Broadbeach Physiotherapy Centre. With one of our in-house physiotherapists, we will complete a thorough assessment, complete any investigations as we see fit, answer any questions about why you are having pain and create a rehab programme based on your unique needs and goals. Together we will work towards minimising your pain and getting you back the activities that you love most.
References:
Edwards, P. K. (2016). Exercise rehabilitation in the non-operative management of rotator cuff tears: A review of the literature. The international journal of sports physical therapy.
Hsu, J., & Keener, J. D. (2015). Natural History of Rotator Cuff Disease and Implications on Management. Oper Tech Orthop, 25(1), 2-9. doi:10.1053/j.oto.2014.11.006
Girish, G., Lobo, L. G., Jacobson, J. A., Morag, Y., Miller, B., & Jamadar, D. A. (2011). Ultrasound of the shoulder: asymptomatic findings in men. AJR Am J Roentgenol, 197(4), W713-719. doi:10.2214/AJR.11.6971
Ingwersen, K. G., Jensen, S. L., Sorensen, L., Jorgensen, H. R., Christensen, R., Sogaard, K., & Juul-Kristensen, B. (2017). Three Months of Progressive High-Load Versus Traditional Low-Load Strength Training Among Patients With Rotator Cuff Tendinopathy: Primary Results From the Double-Blind Randomized Controlled RoCTEx Trial. Orthop J Sports Med, 5(8), 2325967117723292. doi:10.1177/2325967117723292
Lombardi, I., Jr., Magri, A. G., Fleury, A. M., Da Silva, A. C., & Natour, J. (2008). Progressive resistance training in patients with shoulder impingement syndrome: a randomized controlled trial. Arthritis Rheum, 59(5), 615-622. doi:10.1002/art.23576
Mohamadi, A., Chan, J. J., Claessen, F. M., Ring, D., & Chen, N. C. (2017). Corticosteroid Injections Give Small and Transient Pain Relief in Rotator Cuff Tendinosis: A Meta-analysis. Clin Orthop Relat Res, 475(1), 232-243. doi:10.1007/s11999-016-5002-1
Dean, B. J., Franklin, S. L., Murphy, R. J., Javaid, M. K., & Carr, A. J. (2014). Glucocorticoids induce specific ion-channel-mediated toxicity in human rotator cuff tendon: a mechanism underpinning the ultimately deleterious effect of steroid injection in tendinopathy? Br J Sports Med, 48(22), 1620-1626. doi:10.1136/bjsports-2013-093178
Abdulla, S. Y., Southerst, D., Cote, P., Shearer, H. M., Sutton, D., Randhawa, K., . . . Taylor-Vaisey, A. (2015). Is exercise effective for the management of subacromial impingement syndrome and other soft tissue injuries of the shoulder? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Man Ther, 20(5), 646-656. doi:10.1016/j.math.2015.03.013
Haik, M. N., Alburquerque-Sendin, F., Moreira, R. F., Pires, E. D., & Camargo, P. R. (2016). Effectiveness of physical therapy treatment of clearly defined subacromial pain: a systematic review of randomised controlled trials. Br J Sports Med, 50(18), 1124-1134. doi:10.1136/bjsports-2015-095771
