Rotator cuff tendonitis

Shoulder pain is one of the most common problems I deal with as a physiotherapist. It can be very debilitating and frustrating to suddenly be unable to do something as simple as get the milk jug out of the fridge without feeling pain.

Understanding the mechanism by which this condition develops will help you treat it, or help you find the right health care professional to guide you.

Your rotator cuff is made up of four muscles: supraspinatus, infraspinatus, subscapularis and teres minor. Together they form a "cuff" over the head of the humerus, the bone of your upper arm, keeping it in the socket and providing stability. The problem comes from the fact that part of the scapula, or shoulder blade, curves over top of the cuff where it attaches to the humeral head, creating an area at risk for impingement.

Impingement is exactly what it sounds like, it's when the tendon gets pinched between two bones. This can be caused by overuse - repetitious movement over time, poor posture and weakness also play into this. A trauma, for example a motor vehicle accident or a hard blow in sports, can cause inflammation of the tendon causing it to swell, now it occupies more space (in already cramped quarters) and is at greater risk for impingement. Your anatomy may also be at fault, sometimes the space between scapula and humerus is simply abnormally small which would put you at high risk for impingement, or calcium can build up in the tendons over time. These are only a few of the possible causes of your shoulder pain.

The shoulder is a very complex joint, over twenty muscles attach to the shoulder complex, which includes your humerus, scapula and clavicle (collar bone). Therefore if you do not yet have a diagnosis, I would recommend that you seek assessment by a health care professional - your physician or physio - without a diagnosis you are shooting in the dark. However, if you don't have access to a health care professional and want help now, here are some tips.

Self assess:
1. Does your shoulder hurt when you pick things up that are lighter than 5 lbs?
2. Did your pain come on over time, and you don't remember any big trauma or accident?
3. Does it hurt to comb your hair or put on your clothes?

If you said: "Yes!" to all of the above, rotator cuff tendonitis is a definite possibility. Again it would be a good idea to book an appointment with a local physiotherapist/physician.

For now, start with the following measures:
1. Stop doing activities that hurt! If it is painful to lift something, don't. It would only flare up the tendonitis.
2. Try icing your shoulder for 10 -15 minutes, 3 or more times per day. If your sensation is impaired, be careful, you can give yourself frost bite!
3. Don't do ANY strengthening exercises until you can lift your arm past shoulder level WITHOUT pain. At this point gentle strengthening (start with low weight, high repetition exercise) and posture exercises are called for to prevent future flare-ups.

If you've tried the resting and icing for a couple of weeks and the pain have gotten no better or it's worse, go see a health care professional, pain is not normal and waiting too long could make your condition more difficult to treat!