Shoulder Pain Guide: Spotting Rotator Cuff Pain

One of those issues people tend to endure longer than they should endure, is shoulder pain. It begins as a slight ache after exercising, or is a dull ache when reaching high objects. Then it's a nightly nuisance. This then begins to restrict your activities at work, home, and in the things that are important to you.

A large number of these cases are caused by the rotator cuff and the rotator cuff is the aspect of the case that is generally not known. They either ignore it and say that it will pass or they think the worst and believe that surgery is necessary. Both reactions are not useful. The key is to recognize the pain of the rotator cuff, and take action on accurate information.

Function of The Rotator Cuff's

The four muscles of the rotator cuff (supraspinatus, infraspinatus, teres minor and subscapularis) and their tendons encircle and stabilize the shoulder joint. They work together to maintain the head of the upper arm bone in the shallow socket of the shoulder blade, and allow for a great range of movement.

The rotator cuff is working each time you lift, rotate, reach, throw or push. It's under stress while performing many of your everyday tasks, such as dressing, driving, carrying groceries, sleeping on your side. It is highly susceptible to immediate injuries and to wear and tear over time, because of its constant demand.

Primary Conditions - You Need To Know

You need to know two primary conditions:

1. Rotator Cuff Tear

A Rotator Cuff Tear is a tear of one of the four tendons. There are two main types of tears:

a) Traumatic tears - the result from an unexpected, high impact event such as: Fall on an outstretched arm, Heavy lifting, Shoulder Trauma from collision or accident. They tend to make sudden, sharp pain and weakness.
b) Degenerative tears - the results of years of age, repetitive overhead use or decreases in blood flow weaken tendons. There may be no obvious prompting event for these. You may experience more and more weakness, with a dull aching that gradually gets worse.

Tears can also be divided in terms of thickness – partial tears, where the tendon is injured but not completely cut through, and full thickness tears, where the entire thickness of the tendon is cut.

Rotator Cuff Tendonitis and Bursitis

Many people experience a period of inflammation of the tendon (tendonitis) or the fluid filled cushioning sac in the joint (bursitis) before a tear develops. These conditions have some of the same symptoms as Rotator Cuff Tear but affect the condition of the muscles, not the structure. If they are caught and treated at this stage it is often possible to stop them progressing to a tear.

Identifying Rotator Cuff Pain: Important Signs

The pattern of rotator cuff problems is well known. These are the common signs that will be present in everyone but not all:

Pain on the Outer Side of the Shoulder

The pain associated with rotator cuff problems is usually felt on the outer upper arm and front (or top) of the shoulder. Rotator cuff pain is located in the shoulder and can spread down the outer arm towards the elbow (but not below it), unlike neck pain that radiates down the arm in a nerve pattern.

Pain With Specific Movements

The arm motion when lifted to the side, overhead, and back, as well as the arm movement when rotated in and out is all stress on the rotator cuff. If these particular movements are causing pain, and it is not constant and diffuse, the rotator cuff is probably the culprit.

Weakness that is not as intense as the pain

This is an important indicator. Patients typically experience difficulty raising their arm against resistance, holding a weight, or lifting their arm higher than shoulder height with a Rotator Cuff Tear, especially a full thickness tear. Weakness is disproportionate and not just pain-related guarding.

Night pain and sleep disruption

One of the most characteristic features of rotator cuff pathologies is the constant pain, often occurring when lying on the affected shoulder or when the arm is not supported while hanging. If your shoulder pain regularly interferes with your ability to get to sleep or sleep comfortably, then it is not a minor muscle strain.

Pain arc during lifting

Many people with a rotator cuff problem have what's known as a "painful arc," meaning they develop pain when they try to lift the arm in a certain range (typically between 60 and 120 degrees from the side), but the pain subsides when the arm is lifted outside that range. This has a mechanical basis, and is related to the compression of the rotator cuff tendons during that arc of motion.

Clicking, Catching, or Grinding

If there is a structural problem with the tendon or other structures in the shoulder, mechanical sounds or sensations may occur when the shoulder moves. Normal, occasional clicking of the healthy shoulder is normal, but repetitive, painful clicking or a “catching” sensation is not.

Role of Shoulder Trauma

Shoulder trauma is a special area which alters the clinical picture considerably. Even younger patients (without the typical risk factors for degenerative tears) can have an acute Rotator Cuff Tear due to a fall, direct blow, dislocation or impact during a contact sport.

Any trauma to the shoulder, whether big or small, that causes pain, weakness, or decreased mobility beyond 1-2 weeks, should not be discounted as just a bruise. Prompt identification and treatment of traumatic rotator cuff tears have a better surgical outcome due to the progressive increase in difficulty with muscle atrophy and/or retraction over time.

Why is early diagnosis so important?

When symptoms are severe, the “wait and see” approach is not an effective treatment for the rotator cuff. The consequences of late diagnosis are:

• Partial tears may develop into full thickness tears if further loading occurs.
• After the tendon tears, in weeks, muscle attached to the tendon can begin to break down.
• The ends of the tendons pull back into the body, making it more difficult to perform surgical repair.
• Compensatory movements of chronic pain strain the neck, elbow and opposite shoulder.

MRI is the diagnostic imaging modality of choice, it will indicate the condition of the tendon, size of tears, status of the muscles and any associated bursitis or joint changes. Physical examination tests can help to raise suspicion but imaging will confirm diagnosis and direct treatment.

Treatment doesn't always involve surgery

One of the common misconceptions is that as soon as you're diagnosed with a rotator cuff problem, you're headed for the operating room. The truth is more complicated:

• Physical therapy, activity modification and anti-inflammatory medication may be effective for small tears and tendonitis/bursitis.
• In some instances, platelet-rich plasma (PRP) injections are administered to help heal tendons.
• Full thickness tears with marked weakness, failure to heal after 3–6 months of conservative treatment, acute traumatic tears in active patients, high-risk of muscle atrophy are indications for surgery.

If the shoulder instability is combined with a rotator cuff injury, which is frequently seen after shoulder dislocations and/or trauma, surgical planning takes a holistic approach to both problems to restore full joint stability and function.

Conclusion

There is a pattern to rotator cuff pain that can be recognized and early detection is the most important element in a simple recovery. From a degenerative Rotator Cuff Tear to a rupture after Shoulder Trauma to the early stages of Tendonitis which can progress to something more serious, the direction of the future will depend on the right diagnosis, and not speculation.

Our shoulder specialists provide both clinical expertise and cutting-edge imaging to determine exactly what is happening with your shoulder and then devise a treatment plan to address your condition, activity level and goals. The shoulder is too complicated and too important to everyday activity to be left to chance.

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