Is Your Rotator Cuff The Cause Of Your Shoulder Pain?

Bianca Andreescu wins after rotator cuff injury

Many lessons on the nature of a rotator cuff injury and shoulder injury therapy can be learned from Andreescu’s journey.

Rotator cuff tears are a common shoulder injury which can present with any of  the following symptoms:

• Pain in the front and/or outside of the shoulder
• Pain with activities such as lifting the arm overhead
• Decreased strength in the shoulder
• Night shoulder pain

Despite the prevalence of this injury, there are many misconceptions about rotator cuff tears and it’s treatment. This article will focus on helping you to understand the injury and how best to treat it.

Shoulder Anatomy 101

Our shoulder joint is a ball and socket joint.  This shape allows us to have very flexible movements (Figure 2), however it is also less stable than other joints.  The lack of stability makes it more dependent on the muscles to provide support.

The rotator cuff is comprised of 4 muscles which are situated around the shoulder joint:

• supraspinatus
• infraspinatus
• teres majory
• subscapularis

The primary function of these muscles is to stabilize the shoulder during movement (Figure 3). Specifically, while our larger shoulder muscles such as our pectorals and deltoids work to create movements such as lifting the arm, our rotator cuff muscles maintain and controls the positioning of the ball on the socket. This stabilizing function is critical to safe, pain-free movements of the shoulder

(FIGURE 2)

As the shoulder is a complex and mobile joint, we place lots of stress  on the rotator cuff throughout our lifetime. Eventually this cumulative stress can lead to a tear.  A cuff tear can also occur through a more traumatic mechanism such as a fall.

(FIGURE 3)

Do I need Imaging for my Rotator Cuff Injury?

When our shoulder hurts we may be referred for an MRI or ultrasound imaging.  These tests are often prescribed to determine the presence, as well as the severity of a rotator cuff tear. However, recognize that when it comes to shoulder pain, imaging does not tell the entire story.

In 2010, a study looked at the prevalence of rotator cuff tears in people with and without shoulder pain[1]. Imaging was performed on both shoulders. The results showed that 20.7% of people had a rotator cuff tear however 17% of these people had absolutely no shoulder symptoms whatsoever. Additionally, of the people who reported they had shoulder pain, only 36% of them had a tear seen on imaging. This study shows us that imaging is not a perfect tool in determining the cause of your shoulder pain.

Diagnosing the cause of your shoulder pain

A thorough examination is as important as imaging in helping to determine the factors contributing to your pain. To do this your therapist needs to consider many factors to pinpoint the problem.  Typically your examination will include tests for:

• shoulder range of motion
• muscle strength
• stability
• joint stiffness
• postural analysis

Additionally, understanding which activities aggravate your pain, your current activity level and past medical history completes the full insight into your injury. A thorough examination ensures a personalized rehab program that will help get rid of your shoulder pain and return you to the activities you love.

Treatment for my Rotator cuff injury

The final step in your recovery is a comprehensive rehabilitation program.  Your treatment will typically include 3 phases.

1. Pain control.  This consists of using techniques such as therapeutic ultrasound, acupuncture and gentle soft tissue massage to reduce pain.
2. Restore movement. Once pain levels are under control, the goal is for your movement to be returned to normal using therapeutic exercise and hands-on therapeutic techniques i.e. stretching, joint mobilization techniques.
3. Restore strength. Strength training is critical to improve the structural integrity of the rotator cuff.  This allows your shoulder to function more effectively and reduces the risk of injury in the future.

Andreescu’s Injury and her recovery

Bianca Andreescu’s injury can be used as a discussion point on rotator cuff tears and rehabilitation.  Her injury caused her to retire from the 2019 Miami Open tournament[2]. The injury persisted for Andreescu and she was forced to withdraw from Wimbledon in June.

It was later reported that she had suffered from a tear in her subscapularis, which is 1 of the 4 rotator cuff muscles.  The subscapularis aids in internal rotation of the shoulder, which is a movement primarily used in a forehand shot in tennis. Andreescu was able to manage the injury through a solid therapy program and go on to win both the U.S. open and the Rogers Cup in Toronto later that summer.

Andreescu’s recovery is a good lesson for people experiencing their own rotator cuff-related pain. Her story shows that many cuff tears can be managed conservatively without the need for surgery, even in elite-level athletes who have incredibly high demands on their shoulders.

What should you do if you suspect  you have a Rotator cuff injury

If you are having shoulder pain or think you have a rotator cuff injury, contact me, Taylor Sipos, directly at Tsipos@orthophysio.com.  Or call us to make an appointment at 416-925-4687 During our initial assessment I will make sure to gain a comprehensive understanding of your pain and then work with you to determine the best personalized plan to get you back to your activity.