The shoulder joint, or glenohumeral joint, is like a ball in a socket.  The shoulder joint is the interface between the humerus (arm bone), the scapula (shoulder blade) and the clavicle (collar bone).  Because the bony part of the socket of the shoulder is not deep enough to fully contain the top of the arm bone, there is a cartilage ring surrounding the bony joint to further contain and stabilize the arm.  The shoulder capsule is made up of fibrous tissue, helps to hold the arm bone in place inside the joint.   This capsule is fairly lax and allows for a good deal of movement in this joint which is both beneficial and detrimental.

The rotator cuff is a group of four muscles the help to move the arm in the shoulder socket but also serve to further stabilize the arm bone to allow for proper joint alignment and motion.  The 4 muscles in the rotator cuff joint are the supraspinatus, the infraspinatus, the teres minor and the subscapularis.  Each of these muscles have tendons, which serve to connect the muscles to the bone.  The most commonly injured muscle/tendon is usually the supraspinatus.  This is because the supraspinatus runs between two bony surfaces.  Depending on the anatomy of your shoulder, you might be at more risk for injury, especially if there is not much space between theses bony surfaces.  Over time, constant repetitive shoulder motion and friction causes micro-tears and fraying of these tendons.  High velocity injuries such as falls, car accidents or other trauma can cause also partial tears or rupture of these tendons and muscles as well.

Typically, rotator cuff tendonitis pain is brought on by specific movements of the shoulder joint.  Pain is usually located in the front or side of the arm and can radiate down to the elbow.  If the pain radiates further then the elbow, it is more likely your pain is due to a pinched nerve in the neck, rather than from your shoulder.

Rotator Cuff related pain includes (but is not limited to):

• pain with overhead movements
• pain with movements behind the back
• pain with specific motions, but not all shoulder and arm movements
• difficulty sleeping on the affected shoulder (this pain is also related to other shoulder pathology as well)
• pain when raising or lowering the arm

Pain from the rotator cuff can be due to three different but often related issues. If the space between the bones is limited, when you raise your arm overhead, the rotator cuff can get pinched.  This is called impingement, which can be painful on its own.  Repetitive impingement can cause frays and tears of the tendons.    When the rotator cuff tendons get frayed this causes inflammation which leads to further development of pain.  Finally, the third reason for pain is shoulder bursitis.  The shoulder bursa is a fluid filled sac which allows for smooth motion between the tendons.  This sac or bursa can become inflamed and cause a significant amount of pain and point tenderness over the shoulder.

One of the reason for shoulder pain in improper body alignment.  In order for the rotator cuff to work optimally, the scapula or shoulder blade needs to move properly against the back of the chest wall.  Often times, during an exercise routine, you focus more on strengthening certain muscles but not others.  This can lead to muscle imbalance and improper alignment.   In addition, it is important to select the proper weights which are neither too heavy, no too light.  Your muscles should start to fatigue after 8-10 reps of heavy weight lifting but your form should not alter.  If you find that your form deteriorating, then you need to choose slightly lighter weights.

In my personal experience treating rotator cuff tendonitis, it seems that the body has a remarkable ability to heal itself if given the time to do so.  Unless you have specific anatomy which predisposes you to tears and impingement syndrome, usually the shoulder will recover within 6-12 months without much intervention.

That being said, there are interventions which may help with symptom management and prevention of recurrence.   Surgery might be required if you have a full thickness tear, a partial thickness tear and are a high level athlete, or anatomical issues which will not correct on their own.

Generally speaking, rotator cuff tendonitis is treated with rest, ice, and anti-inflammatory measures (either medications or dietary changes).  Sometimes, a cortisone injection into the shoulder is helpful if conservative treatments fail.  In addition, treatments such as PRP (platelet rich plasma) are used to help with regeneration of tissue.   After the initial rest phase, which should be short, as you don’t want to create a frozen shoulder, progressive shoulder motion exercises are recommended.  Once you regain shoulder motion, the next step is strengthening the muscles which fix the scapula (shoulder blade) to the chest wall.

Exercises such as:

• Punches
• Shoulder shrugs
• Rows

are recommended next because proper strength and alignment of these muscles will help to fix the scapula motion with respect to the chest wall.  After you have re-established proper motion and increased the strength of these muscles (such as the rhomboids, latissimus dorsi, trapezius, serratus anterior, pectoralis muscles, etc), then you can progress to specific exercises of the rotator cuff muscle.

The reason you are often referred for physical therapy is that therapists are trained in the proper progression of these exercises and can instruct/monitor you for proper form and technique.  In addition, modalities such as taping, heat, ice, ultrasound, phonophoresis (using ultrasound to help medications penetrate into the shoulder joint, and iontophoresis (using electric current to help medications penetratethe shoulder joint may be effective, though the research studies are equivocal for some of these treatments.    Finally using a shoulder brace may help however, it is important to remove it often to prevent a frozen shoulder.

If you have shoulder issues, make sure to get examined by a medical professional so that you can begin the appropriate treatments and start on the road to recovery.