Articles / That Rotten Rotator Cuff
The shoulder is a busy, mobile sometimes bothersome joint. It’s busy because it’s involved in just about everything we do including feeding, toileting, throwing, lifting, skiing, walking, running, swimming. All these and many more activities indicate range of movement, frequency, speed and repetition of its daily requirements. No wonder it is prone to a wide spectrum of injury and illness.
The shoulder is described as a ball and socket joint. Regrettably the socket is very small and shallow, the ball comparatively large. This anatomical feature permits great range of movement but makes this joint inherently unstable. The joint is enveloped in a capsule or waterproof gristle bag which contains synovial fluid, the oil which helps lubricate and minimize friction in between the connecting bone surfaces. Special thickened bands of fibers in the capsule, the ligaments, arte designed to limit excessive movement.
Producing and permitting these movements is an integrated group of muscles and tendons, which singly or combined guide the arm in the directions we choose.
The tendons are the ropes that attach muscle to bone and work like ropes over pulleys as they glide through narrow grooves and slots. Assisting in minimizing friction and wear and tear are special little bags of fluid each called a burse. The tendons, wedged in their own recesses, and producing all the action form the rotator cuff.
No wonder it gets grumpy from time to time with all this abuse.
The cause of shoulder pain can be difficult to identify. Referred pain, perceived by the patient as a local grievance, can come from many distant source such as heart, lung and other abdominal structures and diseases of other systems. Your doctor has the sometimes tough job of excluding these sources.
Isolating the particular structure at fault can often be achieved using the “APR” test, This involves checking and comparing the patient’s ability to move the arm (Active); the examiner moving the arm for the patient(Passive), and testing each of the tendons ability to push against resistance (Resisted). Most commonly the patient cannot sleep on that shoulder, it hurts during lifting up and out (chicken dance position) and has pain pushing against resistance. In some ranges painful nipping of the tendons and burse under the small outer lid of the shoulder blade is described as impingement.
Treatment by physiotherapy includes:
- Education about the anatomy.
- Advice on how to avoid damage.
- Various modalities including ultrasounds, and ice to lessen inflammation i.e.: tendonitis/bursitis.
- Rest, with careful stretching to prevent the whole capsule of the joint from shrinking up and becoming very stiff and painful (frozen shoulder).
- Avoidance of lifting heavy weights or doing repetitive movements. Habit is the most difficult thing to change. To help minimize aggravation I advise these patients to draw a “happy face” in the palm of the affected hand and try to ensure that during all movements or activities they can still see that happy face. To help lessen the pain provoking movements, i.e.: housework , getting dishes out of high cupboards, etc. I recommend wearing an elastic bungie cord around the elbow tucked in to the side of the body.
As in so many muscle/joint conditions, early treatment for a rotator cuff can reduce the time needed for recovery and return of the smile.
