Rotator Cuff Tendonitis/ Tendinopathy/ Bursitis
One of the most common sources of shoulder pain is the rotator cuff tendons. Rotator cuff tendinopathy is a condition where the tendons of the deeper muscles of the shoulder may become inflamed and painful. This may also be accompanied by sub-acromial bursitis. Generally shoulder pain, stiffness and weakness are the main symptoms of rotator cuff issues and make up a large percentage of patients here at Gold Coast Sports and Spinal Physio.
So what is the rotator cuff?
The rotator cuff is a group of deep shoulder muscles that helps keep the head of the humerus (ball of the shoulder) within the glenoid fossa (socket of the shoulder). These muscles include supraspinatus (most commonly injured), subscapularis, infraspinatus and teres minor. There is also some assistance from the tendon of the long head of biceps which may also be a source of pain. The rotator cuff muscles work together to center the ball in the socket and stabilise the shoulder throughout range of movement. The shoulder socket is actually very shallow with the bony support of the shoulder being compared to a seal balancing a ball on its nose. The rotator cuff muscles essentially create a muscular socket.
What causes rotator cuff tendinopathy?
Rotator cuff tendinopathy is caused when the shoulder is overloaded. This can happen during a fall or trauma but can also happen as a repetitive strain or overuse injury. There may be some muscular imbalances of the muscles of the shoulder blade that can contribute to overload of the rotator cuff.
How can physio help rotator cuff tendonopathy?
The most important thing is getting a thorough shoulder examination to figure out exactly what the source of the problem is. Once this has been established treatment will help loosen tight muscles and strengthen weak muscles as well as improving the way the shoulder moves. By gradually restoring shoulder function and strength, this will allow the tendon to heal under ideal conditions. Treatment may involve:
- Soft tissue massage
- Manual therapy
- Dry Needling
- Shockwave therapy
- Rehabilitation exercises
- Advice on self management
Is bursitis the same thing?
Shoulder bursitis is usually a symptoms of an unhappy tendon and rarely happens in isolation. Bursitis is an inflammation of the sub-acromial bursa - a water balloon like structure that adds cushion between the deltoid and the rotator cuff. If there is an underlying problem with the rotator cuff tendon this will lead to and inflamed bursa. By addressing the tendon problem, we are simultaneously addressing the bursa problem.
Can I have physio if I have had a shoulder injection for bursitis?
Physiotherapy is very important after shoulder injections to help fully resolve the problem. We do usually ask that you wait a week before attending physiotherapy after an injection.
What about rotator cuff tears?
Rotator cuff tears are larger damage to a tendon that may or may not require surgery. Complete ruptures of the rotator cuff (usually supraspinatus) should seek specialist review. Partial tears of the rotator cuff can usually be managed with conservative physiotherapy treatment. Partial and full thickness tears are essentially a severe case of tendinopathy/ tendonitis that will likely require an extended course of treatment and rehabilitation.
Is rotator cuff tendonitis/ tendinopathy permanent?
The short answer is simply NO! Rotator cuff tendinopathy can be a difficult condition to treat and manage and many people find themselves getting frustrated. Sometimes the healing process can be a long back and forth process until the right balance of treatment and strengthening is found. A small minority of patients will have significant structural damage (tendon tears and labral damage) who may require orthopaedic review. The good news is that the vast majority of people will get better with proper management.