Tri State Hand and Occupational Therapy

Newsletter - February, 2006

Shoulder Rotator Cuff

Do you have shoulder pain? Does it hurt when you lift your arms overhead? Does your shoulder hurt when you sleep on it? If you have one or more of these symptoms you may have a rotator cuff problem. I have some suggestions on what to do to get rid of these shoulder problems, but first let’s go over the structures involved.

What is the Rotator Cuff?

The rotator cuff is a collection of muscles and joints in the shoulder that hold the shoulder together. If all the muscles are balanced and equally strong, the shoulder functions normally. However, if any of these muscles become too strong or too weak, the boney structures begin to rub together. This may cause pinching of tendons or rubbing of other tendons resulting in tendonitis. The result is that you feel pain which may be an ache, sometimes a deep ache. The pain typically is felt in the shoulder and radiates on the outside of the shoulder via a nerve called the axillary nerve.

The movement of the shoulder offers great flexibility. You can literally move your arm in a large circle. You can reach behind your back (at least you should be able to). All this flexibility in the shoulder has a price. Because the shoulder is so flexible, it is also vulnerable to injury and for things to get out of whack. Let me explain.

Symptoms and Dysfunction

What happens to the rotator cuff to cause pain? Typically there are a few patterns of people’s activities that lead to problems. The most common cause is overhead reaching or lifting. Repetitive overhead activities strengthen the middle deltoid which attaches to the arm bone (humerus). This pulls the bone up into the top of the socket. This pinches the muscle that attaches to the arm bone. Also, it may push the arm bone into the shoulder blade causing a sort of bone bruise called periostial pain. It is a deep and persistent ache referred to as impingement syndrome. This is the most common problem we see.
The other common cause is heavy repetitive use of the arm for activities such as lifting, throwing, swinging a club or bat, and such. This overuse type of pain starts out only hurting after overdoing it. Later it begins to hurt at rest or even putting on a sweater. Sometimes warming up will help it feel better temporarily. This is due to inflammation and eventually deterioration of the muscles and tendons. This can lead to fraying or even tearing of the rotator cuff muscles and tendons which attach to the bones in the shoulder.

To get rid of these types of problems, it takes treatment in several stages.

Stage I: First, we reduce inflammation in the shoulder. We use ultrasound with cortisone cream, ice, electrical stimulation. A sling is only rarely necessary in very severe cases. Proper sleep position is also taught. The goal is to reduce the pain so the patient can tolerate therapy better. Avoid provocative activities which increase the pain if at all possible.

Stage II: We begin simple range of motion of the shoulder. However, we move the shoulder within tolerable limits. This is to make sure the joint and tendons do not get too ‘sticky’ and when that happens the shoulder can freeze up resulting in ‘frozen shoulder’ or ‘adhesive capsulitis’. These are just fancy terms meaning a very stiff and sore shoulder. This is more prevalent in people with diabetes.

Stage III: Once pain is controlled and range of motion begins to normalize we stretch certain muscles to help heal the rotator cuff and we strengthen certain muscles to keep the bones and tendons from rubbing together too much.

Stage IV: We are in complete full strengthening of the shoulder. Normal activities and work can be resumed. You may need a home program after stopping therapy to keep symptoms from reoccurring.

Summary: Remember to avoid painful activities that irritate and inflame the shoulder. Use ice for 20 minutes with a moist towel between the ice and skin when you begin experiencing symptoms. If symptoms persist, talk with your doctor or give us a call. If addressed early, rotator cuff problems may be easily addressed. We can teach you to strengthen the rotator cuff and keep it healthy. However, letting it go when symptoms persist can lead to serious problems that may require surgery and/or cortisone injections. Regardless, unless you correct the underlying structural imbalances by properly stretching and strengthening, the rotator cuff symptoms may persist.

Give us a call at TriState Hand and Occupational Therapy for your shoulder pain and problems. You will get a detailed assessment, your problem will be explained to you and your questions answered. Most importantly, you will be satisfied with our service. Your satisfaction is our highest goal. Give us a call at 301-759-4263. Try therapy first with us, you will be glad that you did.

TIPS

If your shoulder hurts more than 6 weeks see your doctor or give us a call.

Rotator cuff pain usually starts in the shoulder and radiates down the outside part of shoulder via the axillary nerve.

Use ice with a moist towel on the shoulder for 20 minutes 3 times a day early on when your shoulder is painful.

Pain with overhead reaching or pain sleeping on the painful shoulder indicates rotator cuff problems.

Get treatment early. Waiting will only make treatment longer and more difficult. It can help avoid injections and surgery.