Shoulder pain may arise due to many varying factors, and include multiple structures (muscles, tendons, joint capsule, cartilage, bone). Arguably the most common muscles/tendons involved in shoulder complaints are the rotator cuff muscles. For this reason, we will focus on these structures.
It is important to note that the treatment of shoulder complaints believed to be caused by musculoskeletal structures does not vary to a great degree. Therefore, the treatment approach may begin the same, and be adjusted as you progress to ensure best outcomes/results.
What is the Rotator cuff?
The rotator cuff is a group of shoulder muscles comprised of the:
- Teres minor
These muscles play a significant role in the support and function of the shoulder (glenohumeral joint).
Types of rotator cuff tears
- Partial thickness tears
o A tear that does not disrupt the full depth of the tendon or muscle (these are the most common type)
o Partial thickness tears often progress to full thickness tears (Jeanfavre, Husted & Leff, 2018)
- Full thickness tears
o A tear that passes through the entire thickness of the rotator cuff muscle or tendon
o Full thickness tears are more often associated with pain, disability, and altered function
What causes rotator cuff tears?
There are many possible reasons for a rotator cuff tear to occur. However, it is important to remember that rotator cuff tears are a common occurrence, with incidence increasing with age. Prevalence has been shown to be anywhere from 9% in those under 20 years of age to 62% in those 80 years or over (Sambandam et al., 2015).
Factors that can increase your chance of having a rotator cuff tear include:
- Increased age (occurrence increases as you get older)
- Heavy manual labour at work or in your physical activities
- Family history
- High cholesterol
Tears do not always produce pain or disability. So it is important not to assume a tear seen on a scan is directly causing your pain or limited function. The scan is only a still image, and does not tell us what is causing the pain, or how the shoulder is functioning with the tear.
Sleep and rotator cuff tears
Sleep can often be blamed for causing or aggravating a shoulder injury. Currently there is no evidence to suggest sleep has a causative effect on shoulder injuries or pain, in fact there is evidence that refutes the belief your sleeping position can cause or worsen your shoulder pain (Holdaway et al., 2018).
It is more likely that your shoulder is uncomfortable at night or in the morning due to being less distracted by other activities, activities you did the day before, or due to inflammatory changes in the shoulder (which are typically worse at night and in the morning).
Injections for rotator cuff tears
Sometimes it is recommended you receive an injection (typically cortisone, a steroid) into the shoulder to relive the pain. You may have even had an injection previously, or know someone who has. Current evidence suggests that injections may provide some pain relief, however it is often short-term (up to 8 weeks) (Cook & Lewis, 2019), and does not heal the tear.
Surgery for rotator cuff tears
Current evidence suggests that Individuals with full thickness tears appear to have similar improvements in outcomes over 12 months regardless of whether they received surgical or non-surgical intervention. For this reason, it is advised to seek non-operative treatment (eg: manual therapy, exercise rehabilitation) in the first 12 months, due to the natural progression of full thickness tears.
Non-Operative treatment for rotator cuff tears Insert random treatment picture
This is where your osteopath can help. Non-operative treatment (often referred to as conservative treatment) may consist of multiple approaches. A tailored management plan will be developed based on your activity level, work duties, age, training history, level of function of the shoulder, level of pain, as well as how long you have had the shoulder pain.
A management plan may include:
- Recommendations to seek advice on pain medications from your pharmacist or G.P.
o Eg: Panadol, ibuprofen etc..
- Education on what structures may be relating to your shoulder pain, and pain education
- Advice on lifestyle factors to address (smoking, diet, physical activity, work postures/tasks)
- Exercise prescription
Manual therapy (massage, dry needling, taping, manipulation, mobilisation