Rotator Cuff Syndrome: Causes, Symptoms & Chiropractic Rehabilitation Options
A rotator cuff tear is a tear in either one or more of the four muscles that make up the rotator cuff of the shoulder. These tears are a common shoulder condition that we frequently encounter in clinical practice. Statistically rotator cuff injuries affect up to 30% of the population during their lifetime. Males are more likely to suffer from rotator cuff tears, however this condition can appear in all types of individuals ranging from athletes, physical workers, elderly as well as anyone from the wider population.
The rotator cuff plays an important role for shoulder stability helping to keep your shoulder joint well aligned as well as ensuring normal arm movement and mobility.
CAUSES OF ROTATOR CUFF SYNDROME
Generally speaking there are four common ways that an individual may sustain rotator cuff syndrome.
- Acute Trauma & Direct Injury: Trauma may be the result of activities such as sports injuries, falls as well as lifting and lowering objects
- Repetitive Overuse: Continual or repetitive overloading the shoulder joint and associated rotator cuff muscles may contribute to micro-tears
- Age Related Degeneration: As we age soft tissue and connective tissue structures weaken contributing to an increased risk of injury and degeneration
- Associated Conditions: Individuals may sustain rotator cuff syndrome due to suffering associated shoulder complaints such as Supraspinatus injury, Labral tears, Bursitis, Shoulder instability or Shoulder impingement syndrome
ROTATOR CUFF SYNDROME SYMPTOMS
Rotator cuff injury signs & symptoms may vary depending upon severity and the exact location of the injury. Given this, general symptoms which may indicate that you’re suffering from rotator cuff syndrome can include (but not limited to):
- Pain on the upper or outer shoulder region
- Night pain that may contribute to difficulty sleeping or lying on the affected shoulder
- Shoulder weakness during particular movements
- A clicking or ‘popping’ type sensation in the shoulder in the presence or absence of pain
- Swelling and associated skin changes
DIAGNOSIS OF ROTATOR CUFF RELATED INJURIES
Diagnosing a rotator cuff tear is very thorough process as it is essential to locate the specific muscle that is torn or injured. This will allow the appropriate treatment to occur. It is important for you practitioner or health care professional to rule out other possible differential diagnoses before commencing treatment. A consultation with a therapist such as a Chiropractor or Physiotherapist may include the following analysis:
- Review of medical history: This is important as your practitioner needs to understand the exact mechanism of injury, location of pain, quality of pain and potential aggravating factors
- Physical examination: An assessment may include palpation of the shoulder region, muscle testing to observe for weakness or asymmetries, range of motion of the shoulder girdle as well as various condition specific orthopaedic and neurological tests if required
- Referral for imaging may be clinically indicated: In particular cases your treating practitioner may suggest referral to your general practitioner for further analysis such as X-ray, Ultrasound, MRI or CT
TYPICAL TREATMENT OPTIONS
Conservative and non-invasive management such as Chiropractic & Physiotherapy are a fantastic option for treating such injuries. These modalities may be used alone or in conjunction with medical assistance. Depending upon severity of injury, sufferers may expect rehabilitation times of between weeks to several months. Other helpful management strategies may includ
- Avoiding activities that aggravate the pain and dysfunction
- Resting the injured area to assist with reducing inflammation, overall pain and improving general function
- Other anti-inflammatory measures such as ice application to the injured area, anti-inflammatory medication as well as dietary or nutritional changes
Chiropractic & Physiotherapy
Chiropractors & Physiotherapist’s are musculoskeletal therapist’s that are qualified in sports injury management protocols. Treatment may include:
- Strategies to assist with reducing inflammation such as ice/heat, ultrasound application, laser and shockwave therapy
- Soft tissue therapy to assist with injury healing and reducing pain as promptly as possible
- Exercises designed to improve shoulder range of motion and therefore allow for treatment progression towards strengthening based exercises
Corticosteroid injections are a worthwhile management option for those individuals suffering from excessive acute pain and dysfunction. These types of injections are recommended to reduce inflammatory pain in the shoulder region. Commonly the injection will take place directly into the injured site. It is important to recognize that these injections are not designed to assist healing and recovery but more so to assist individuals reducing their current pain level.
While rare, surgical intervention such as arthroscopy may be warranted if all other treatment methods have been exhausted and deemed unhelpful. It is recommended that you discuss various surgical intervention options with your general practitioner.
WHAT DOES THE RESEARCH TELL US?
- Conservative treatment may lead to satisfactory results when it’s administered to individuals who have well preserved shoulder range of motion and strength. If more severe cases, alternative treatment methods should be considered and referred for appropriately. Itoi, E. (1992). Conservative treatment of rotator cuff tears. Clinical Orthopaedics & Related Research, 165 – 173.
- Statistically significant improvements were obtained in shoulder range of motion, pain and general function from conservative management. Baydar, M. (2009). The efficacy of conservative treatment in patients with full-thickness rotator cuff tears. Rheumatology International, 29(6); 623 – 628.