The Rotator Cuff (RC) is a group of four muscles which provide internal and external rotation torque at the shoulder. Their role is to provide dynamic stability to the shoulder joint, keeping the head of the humerus firmly fixated in the shoulder socket when the arm is required to move.
RC tendinopathy is one of the most common musculoskeletal disorders affecting athletes and the general population. It’s the most common type of shoulder pain, accounting for approximately 30% of all shoulder complaints.
While the exact etiology of rotator cuff tendinopathy isn’t fully understood, it’s believed to develop when excessive loads exceed the healing capacity of tendon cells, causing pain and impaired function as a result of improper healing processes.
RC tendinopathy is complex and can be attributed to intrinsic and extrinsic mechanisms, as well as environmental contributions. Occupational risk factors include repetitive arm movements, working with hands above shoulder height, direct load bearing, heavy work, sustained postures and high workload with minimal rest. Intrinsic mechanisms are those that directly influence tendon health and quality, such as aging, genetics, degeneration, tendon overload, overuse, trauma, altered biology and microvascular blood supply.
While extrinsic mechanisms are anatomical variants that can lead to impingement such as acromial shape, subacromial joint spurs and acromioclavicular joint spurs. These mechanisms coupled with overuse can predispose an individual to RC tendinopathy.
Symptoms of RC tendinopathy include pain and weakness, especially with shoulder elevation and external rotation. Tenderness over the shoulder joint, dull ache, pain when reaching overhead, to the side or behind the back and discomfort with lifting or sleeping on the affected side. RC tendinopathy usually affects the dominant shoulder.
Individuals are often sent for imaging to diagnose shoulder complaints. However, research shows that clinical findings on scans don’t always correlate with musculoskeletal symptoms. Individuals who have imaging signs indicating RC tendinopathy are often asymptomatic, with no pain or functional deficits which can complicate diagnosis and treatment.
Treatment involves employing strategies to manage tendon loading and to progressively restore muscle strength, coordination, stability and ultimately restore shoulder function. Avoiding exercises all together results in stiffer, sorer tendons. While overdoing it will result in the tendon staying sensitive. It’s important to find a manageable level of exercise that allows the tendon to settle. Education, lifestyle and activity modifications play an important role in RC tendinopathy rehabilitation. Adequate time (approximately 100 days) and appropriate management are mandatory to ensure positive long term outcomes.
To recap, rotator cuff tendinopathy is an overuse injury that occurs when the body fails to regenerate adequately causing tendon disorganisation and thickening which impairs the physical properties of the tendon. Tendons don’t need rest, as it doesn’t change the pathology of the tendon and will simply prolong rehabilitation. Tendons take approximately 100 days to improve and exercise keeps them healthy. Exercise isn’t harmful for tendons, unless they are being repetitively overloaded without rest. Lifestyle factors such as smoking, obesity and metabolic syndrome may significantly impact recovery in those with RC tendinopathy.
If you are experiencing shoulder pain, seek medical attention early to prevent poor long term outcomes. Your local physiotherapist in Kew or Physiotherapist in Oakleigh will be able to assess and diagnose your condition without the use of imaging in most instances and create a treatment plan in conjunction with you and your individual needs.
References
1. Spargoli, G. (2019). Treatment of rotator cuff tendinopathy as a contractile dysfunction. A clinical commentary. International journal of sports physical therapy, 14(1), 148-158.
2. Lawrence, R. L., Moutzouros, V., & Bey, M. J. (2019). Asymptomatic Rotator Cuff Tears. JBJS reviews, 7(6), e9-e9. doi:10.2106/JBJS.RVW.18.00149
3. Lewis, J., McCreesh, K., Roy, J.-S., & Ginn, K. (2015). Rotator Cuff Tendinopathy: Navigating the Diagnosis-Management Conundrum. Journal of Orthopaedic & Sports Physical Therapy, 45(11), 923-937. doi:10.2519/jospt.2015.5941
4. Factor, D., & Dale, B. (2014). Current concepts of rotator cuff tendinopathy. International journal of sports physical therapy, 9(2), 274-288.
5. Sambandam, S. N., Khanna, V., Gul, A., & Mounasamy, V. (2015). Rotator cuff tears: An evidence based approach. World journal of orthopedics, 6(11), 902-918. doi:10.5312/wjo.v6.i11.902
