We often see patients who visit us with shoulder pain as it can be difficult to sleep on your shoulder, drive your car, and even other things like putting a t-shirt on. The most common cause of shoulder pain is rotator cuff related pain. To learn more about rotator cuff related pain and what you can expect in your shoulder rehabilitation we’ve created this easy to read article.
Your shoulder is actually made up of 3 different joints! The scapulohumeral joint (shoulder joint), Acromioclavicular joint (collar bone joint), and the scapulothoracic joint (shoulder blade joint). It’s important all 3 of these joints can move well in order for your rotator cuff to function.
Your rotator cuff is made up 4 different muscles, the infraspinatus, supraspinatus, subscapularis and teres minor, and the tendon of the long head of the bicep is also closely related to the rotator cuff. The supraspinatus is the most commonly affected muscle in the rotator cuff involving up 70% of all shoulder related pain. To help all these muscles and joints move smoothly your shoulder contains a bursa. A bursa is a fluid sac that lubricates the shoulder. The subacromial bursa can be aggravated with rotator cuff related pain. If a bursa becomes inflamed then this is called a bursitis.
Rotator cuff related pain is often described as a dull ache in the shoulder and upper arm. You can also experience sharp pains on quick movements. Rotator cuff pain is always mechanical, meaning “my shoulder hurts when I do this”. Muscle spasm can create stiffness in the shoulder making everyday activities painful and limit your ability to move your shoulder. Typically, people will struggle with reaching movements such as lifting a hand bag from the back seat of the car or lifting luggage from the back of a car boot.
Rotator cuff related pain can be caused by various different pathologies but the most common are;
Other shoulder conditions can include;
Diagnosing a rotator cuff related tear or tendinopathy often doesn’t require imaging however, your physiotherapist may order an x-ray and ultrasound if they have concerns about a larger tears that may require surgical opinion or want to rule out less common causes for shoulder pain. Not all findings on imaging may be relevant to your particular shoulder condition. Your physiotherapist or doctor will need to identify the correlations between your reported symptoms, clinical tests, and imaging findings to identify the main drivers for your shoulder pain. It’s important we treat the person and not the image!
Most shoulder rehabilitation plans will take between 8 to 12 weeks but this can vary significantly depending on the severity of condition. Co-existing health conditions, the level of desired function, and your current lifestyle can also impact the length of your rehabilitation. However, all shoulder rehabilitation will typically consist of four components.
This can include acupuncture, dry needling, massage and joint mobilization. These techniques are used to reduce your pain and facilitate an increase in range of motion of your shoulder. This can help accelerate the beginning phases of your rehabilitation and lead to a quicker discharge date.
Sometimes shoulders are too sore to tolerate any exercise. In this case taping or the use of a brace is used to offload the damaged tissues allowing the pain settle before a graded exercise program begins.
A graded exercise program is essential in rotator cuff rehabilitation. A well structured graded exercise program focuses on addressing any deficits from the damaged tissues and ensuring your shoulder has good strength throughout its entire range of motion. As a rule of thumb, therapeutic exercise prescription aims to achieve a low level of irritability. Meaning that the pain should be very manageable and gone within the first hour after completing the exercise.
It’s important to know what outcome measures you and your physiotherapist will use to decide when you’re happy to part ways. Nobody wants to continue doing physio exercises forever!
The LSI calculates the amount of force your injured rotator cuff can exert using a dynamometer and then divides the score against your non-affected shoulder. For example, if your non injured shoulder can exert 20kg of force then it would be advised to continue your rehabilitation until your injured shoulder can produce a force greater 16kg, giving you a limb symmetry index of 80%. The closer the score is to 100% the better.
This test involves balancing a 2kg medicine ball on the palm of your hand as your shoulder moves through a series of movements out to the side and above your head. The test is performed for 60 seconds and measures strength, endurance and motor control.
Lastly, the most important outcome measure is whether or not you are happy with your shoulder and if you have been able to go back to your desired activities. This is scored by you using a 1 to 10 scale on the Patient Specific Functional Scale Questionnaire or PSFSQ.
After the rehabilitation has been completed it is common to ask what the risk of re-injury is. While this can vary greatly depending on the nature of your shoulder injury, your occupation and sport. Generally if you have a well moving and strong shoulder that is conditioned to your sport and occupation then your risk of re-injury should remain low.
We have experienced senior clinicians with one of the best equipped facilities on Auckland’s North Shore. We are part of several ACC programs, and you may be eligible to receive fully subsidised healthcare for your injury. To find out more don’t hesitate to book online or contact us on 09 5536565.
17/18 Link Drive Wairau Valley, Auckland 0627
hello@linkhealthandfitness.co.nz
09 5536565Gym – 24hrs / 7 Days
