Why Do I Have Rotator Cuff Pain?

Overview 

The rotator cuff connects the humerus to the scapula and is made up of the tendons of four muscles, the supraspinatus, infraspinatus, teres minor and the subscapularis. Tendons attach muscle to bone. Muscles move bones by pulling on the tendons.  The muscles of the rotator cuff keep the humerus tightly in the socket. 

Cause of injury

  • Pushing off with your arm –  When using your arms to raise out of a chair, which can be due to leg weakness, the space between the shoulder’s socket and humerus is decreased, which can cause crushing and grinding the rotator cuff tendons. 
  • Repetitive reaching — Overhead arm positions narrow the small space that the rotator cuff tendons must pass through. Improper repetitive form with exercises such as –  Pushups, pitching a baseball, swimming, house painting, building construction, auto mechanic work, and other activities can cause injury. 
  • Abrupt or Forceful overhead arm movements — Tears are particularly common in athletes in  throwing sports, swimming, wrestling, and  racquet sports. An automobile accident or falling onto an outstretched arm can also lead to potential tears.
  • General weakness — Your shoulder can be injured more easily if it is out of shape. When out of shape your tendons and muscles can become inflamed, or move in improper patterns ( one muscle pulls more than the other) When this happens, routine shoulder movements are more likely to cause tendon friction, which can lead to pain with movement. 

Diagnosis 

A physical examination is the most usual way to diagnose a rotator cuff injury. Your Physical Therapist will rotate your arm at the shoulder and then will raise your arm. If this type of motion causes pain, the rotator cuff may be inflamed. If you have noticeable weakness, you will need further testing to check for a rotator cuff tear. 

What if I have a tear? 

Partial thickness tears have good potential to heal if they are less than 50% of the thickness of the tendon. If you have a small tear, your doctor may refer you to physical therapy to encourage proper strengthening while the tendon is healing.

If a large tear is suspected, the doctor will commonly have an (MRI) scan performed to confirm the diagnosis. 

If you have recurring rotator cuff injuries or large tears in a rotator cuff tendon, surgery may be necessary. Either arthroscopy (camera-assisted surgery) or traditional open surgery can be used. 

Treatment/ Prevention 

Physical therapy: Physical therapy is arguably one of the best things you can do for rotator cuff tears whether you had surgery or not. What can they offer: 

  • Pre-Hab: If surgery is needed to repair a large tear, your physical therapist can provide you with a treatment plan to increase strength prior to surgery. Goal of pre-hab is to help prepare you for post surgery recovery. 
  • Post-Surgical rehab: Therapy post-surgery is crucial to rehab the shoulder back to functional range of motion and strength.  
  • Exercises that strengthen the rotator cuff muscles to make your shoulder less vulnerable to injury. To see a few stabilization exercises, check out our blog.
  • They can also help improve posture and form with movements to prevent space narrowing in the shoulder and to decrease friction.
  • Provide manual therapy to increase range of motion and decrease pain. 
  • At Pittman PT, we offer Laser Therapy which can help increase the healing process.