Rotator cuff pain is common in both young athletes and middle-aged people. Young athletes who use their arms overhead for swimming, baseball, and tennis are particularly vulnerable. Those who do repetitive lifting or overhead activities using the arm, such as paper hanging, construction, or painting are also susceptible. Pain may also develop as the result of a minor injury. Sometimes, it occurs with no apparent cause.
Rotator Cuff pain can be the result of:
- Tendinitis. The rotator cuff tendons can be irritated or damaged.
- Bursitis. The bursa can become inflamed and swell with more fluid causing pain.
- Impingement. When you raise your arm to shoulder height, the space between the acromion and rotator cuff narrows. The acromion can rub against (or "impinge" on) the tendon and the bursa, causing irritation and pain.
No matter what the cause, rotator cuff pain commonly causes local inflammation and tenderness in the shoulder. Typically this pain is felt on the side or occasionally the back of the shoulder and may feel like it is actually in the upper arm. You may have this pain and stiffness when you lift your arm. There may also be pain when the arm is lowered from an elevated position. Early on you may feel any of the following:
- Minor pain that is present both during activity and possibly at rest
- Pain radiating from the front or back of the shoulder to the side of the arm
- Sudden pain with lifting and reaching movements
- Athletes in overhead sports may have pain when throwing or serving a tennis ball
These early symptoms may be mild. Patients frequently do not seek treatment at this early stage but often self treat with changing activities and taking over the counter pain medications.
If these are not effective and the problem progresses, then symptoms can increase and lead to:
- Pain at night, with disturbance of sleep
- Loss of strength and motion
- Difficulty doing activities that place the arm behind the back, such as buttoning or zippering. If the pain comes on suddenly, the shoulder may be severely tender. All movement may be limited and painful.
If pain progresses, interfering with work, activity or sleep, then evaluation with an orthopedic surgeon is the next step. After discussing your symptoms and medical history, your doctor will examine your shoulder. He or she will check to see whether it is tender in any area or whether there is a deformity. To measure the range of motion of your shoulder, your doctor will have you move your arm in several different directions. He or she will also test your arm strength with your arm in different positions.
Your doctor will check for other problems with your shoulder joint. He or she may also examine your neck to make sure that the pain is not coming from a "pinched nerve," and to rule out other conditions, such as arthritis.
NONSURGICAL TREATMENTS
The goal of treatment is to reduce pain and restore function. In planning your treatment, your doctor will consider your age, activity level, and general health.
In the vast majority of cases, initial treatment is nonsurgical. Although nonsurgical treatment may take several weeks to months, many patients experience a gradual improvement and return to function.
Rest: Your doctor may suggest more rest and different activity modifications.
Non-Steroidal Anti-Inflammatory Medicines: Medications like ibuprofen and naproxen reduce pain and swelling may be more effective in treating rotator cuff pain.
Physical Therapy: A physical therapist will initially focus on restoring normal motion to your shoulder. Stretching exercises to improve range of motion are very helpful (see figure at right). If you have difficulty reaching behind your back, you may have developed tightness of the posterior capsule of the shoulder. Specific stretching of the posterior capsule can be very effective in relieving pain in the shoulder. Once normal flexibility is restored and the pain begins to improve, then a program to re-establish strength, balance and endurance in the rotator muscles is begun.
Steroid Injection: If rest, medications, and physical therapy do not relieve your pain, an injection of a local anesthetic and a cortisone preparation may be helpful. Cortisone is a very effective anti-inflammatory medicine. Injecting it into the bursa beneath the acromion can relieve pain.
In the event that these non-surgical, minimally invasive, measures do not result in decreased pain and return to normal function and activity then an MRI to evaluate the structure of the rotator cuff would be indicated to determine if more invasive treatment, like surgery might be necessary.
If you have questions or wish to schedule an evaluation, please call us at (253) 833-7750.
