Whalley Physiotherapy

Shoulder Issues: Early diagnosis and treatment.


The shoulder joint is a relatively unstable ball and socket joint that is moved and controlled by a small group of four muscles known as the rotator cuff. These muscles and their tendons surround the shoulder joint and are responsible for stabilising the head of the humerus firmly within the shallow socket of the shoulder and shoulder rotation.

The tendons run under a bony protective arch over the top of the shoulder (acromion which is part of the scapula) in between which sits the subacromial bursa (a lubricating sack) which helps protect the tendons from rubbing against the bone. It’s under this arch that the tendons are vulnerable to being damaged by being intermittently trapped and compressed during shoulder movements. Repetitive overhead activities like decorating, overhead sports like netball, heavy prolonged lifting and the development of bone spurs in the bones around the shoulder may irritate or damage the tendon resulting in a Rotator cuff impingement syndrome. This is when the damaged tendon catches under the boney acromion resulting in, amongst other things, a painful arc when lifting the arm out to the side and up.

A tear in the rotator cuff  can also be caused by a single traumatic event such as falling onto an outstretched arm or due to age related degenerative wearing of the tendon itself. The damage is common in people over 40.

A tear in the rotator cuff can severely restrict movement of the arm. The pain is described as a dull ache deep in the shoulder, sometimes radiating down the top of the arm and is common at night especially lying on the affected side. It’s  particularly painful reaching behind your back or activities like combing your hair or reaching for your seatbelt.

Your physiotherapist will suspect a rotator cuff injury based on your clinical history and the findings from a series of clinical tests. It is important to get the pain under control and promote healing of the tendon, say with ultrasound, whilst doing guided exercises to strengthen and improve the flexibility of the shoulder without aggravating the injured tendon.  Postural correction is an important part of rehabilitation especially working on the muscles that control the scapula position to help minimise the impingement of the tendon under the acromion.

Atraumatic, degenerate tears generally don’t do well with  surgical repair but shoulder movement can be recovered with specific exercises lead by your physiotherapist. On the other hand an injury causing a traumatic tear can be repaired surgically and should be considered as soon as possible for the best outcome. A diagnostic ultrasound scan is the most accurate method to diagnose the specific rotator cuff injury pathology. MRI’s may show a rotator cuff injury but sometimes they’re missed whereas X-rays are of little diagnostic value.

So, the key to recovery is . Immobility of the shoulder due to pain or weakness can cause secondary problems like a frozen shoulder so advice and the right exercises are paramount.

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