The rotator cuff is a group of four muscles that start on the shoulder blade and cover the ball of the shoulder joint. Their job is to keep the ball of the shoulder joint (humeral head) centered and compressed into the socket. Without proper rotator cuff activation or strength, the humeral head will move upwards in the socket with elevation of the arm, narrowing the distance between the humeral head and the AC joint overtop, leading to a higher chance of subacromial impingement.
Injuries to the rotator cuff can come from trauma, overuse (especially in overhead positions), or wear and tear. Interestingly, there is a large percentage of the population over 50 years old with rotator cuff pathology on imaging (either MRI or ultrasound) that is asymptomatic – so not all rotator cuff issues are painful.
The most common symptoms of rotator cuff tendinopathy and/or subacromial impingement include:
- Pain most commonly in the front and/or outside of the shoulder
- Pain with arm elevation between 60 degrees to 120 degrees (called a painful arc) and in full elevation
- Pain limited range of motion especially with moving the arm overhead or behind the back
- Weakness
- Night pain
Conservative care for rotator cuff tendinopathy and/or subacromial impingement syndrome includes:
- Pain reduction for irritable rotator cuff tendinopathy. This can include avoiding aggravating activities/positions and exercising within levels that do no worse overall shoulder pain. Guidelines for pain management in non-irritable rotator cuff tendinopathy are to avoid or reduce movements/activities/exercises that increase night pain or pain levels for 24 hours after completion of that activity.
- Exercises aimed at progressive rotator cuff, scapular, and postural muscle strengthening. Progressive rotator cuff strengthening will gradually load the injured tissues, stimulating them to get strong and build capacity. Scapular and postural muscle strengthening will optimize the biomechanics of the shoulder blade, making sure the rotator cuff functions in the best position possible. Researches suggest that a structured exercise program can significantly reduce the need for surgery. If an exercise approach is not enough to relieve symptoms, researchers have found no difference in outcomes in patients who immediately have surgery vs. those who delayed surgery to trial exercise first.
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DISCLAIMER: This information is not intended as medical advice or a substitute for medical counseling. By choosing to follow the information that follows, you recognize that despite all precautions taken by Physio Fixes Inc. there is a potential risk of injury and you expressly acknowledge such risks and waive, relinquish, and release any claim that you may have against Physio Fixes Inc. You should always get evaluated for exercise by a physician or medical professionals, especially if symptoms occur from a trauma or are worsening. The user agrees by purchasing this program that Physio Fixes will not be held responsible in the event that an injury occurs.
References
American Academy of Orthopaedic Surgeons. Management of Rotator Cuff Injuries Evidence-Based Clinical Practice Guideline. www.aaos.org/rccpg. Published March 23, 2020.
Boland K, Smith C, Bond H, Briggs S, Walton J. Current concepts in the rehabilitation of rotator cuff related disorders. J Clin Orthop Trauma. 2021 Apr 18;18:13-19. doi: 10.1016/j.jcot.2021.04.007. PMID: 33987078; PMCID: PMC8082254.
Doiron-Cadrin P, Lafrance S, Saulnier M, Cournoyer É, Roy JS, Dyer JO, Frémont P, Dionne C, MacDermid JC, Tousignant M, Rochette A, Lowry V, Bureau NJ, Lamontagne M, Coutu MF, Lavigne P, Desmeules F. Shoulder Rotator Cuff Disorders: A Systematic Review of Clinical Practice Guidelines and Semantic Analyses of Recommendations. Arch Phys Med Rehabil. 2020 Jul;101(7):1233-1242. doi: 10.1016/j.apmr.2019.12.017. Epub 2020 Jan 31. PMID: 32007452.
Heron SR, Woby SR, Thompson DP. Comparison of three types of exercise in the treatment of rotator cuff tendinopathy/shoulder impingement syndrome: A randomized controlled trial. Physiotherapy. 2017 Jun;103(2):167-173. doi: 10.1016/j.physio.2016.09.001. Epub 2016 Sep 21. PMID: 27884499.
Lafrance S, Charron M, Roy JS, Dyer JO, Frémont P, Dionne CE, Macdermid JC, Tousignant M, Rochette A, Doiron-Cadrin P, Lowry V, Bureau N, Lamontagne M, Sandman E, Coutu MF, Lavigne P, Desmeules F. Diagnosing, Managing, and Supporting Return to Work of Adults With Rotator Cuff Disorders: A Clinical Practice Guideline. J Orthop Sports Phys Ther. 2022 Oct;52(10):647-664. doi: 10.2519/jospt.2022.11306. Epub 2022 Jul 26. PMID: 35881707.
Lee DYL, Haas R, Wallis JA, O’Connor DA, Buchbinder R. Clinical practice guidelines for the management of atraumatic shoulder conditions: protocol for a systematic review. BMJ Open. 2021 Apr 7;11(4):e048297. doi: 10.1136/bmjopen-2020-048297. PMID: 33827850; PMCID: PMC8031683.
Lewis J, McCreesh K, Roy JS, Ginn K. Rotator Cuff Tendinopathy: Navigating the Diagnosis-Management Conundrum. J Orthop Sports Phys Ther. 2015 Nov;45(11):923-37. doi: 10.2519/jospt.2015.5941. Epub 2015 Sep 21. PMID: 26390274.
Littlewood C, Ashton J, Chance-Larsen K, May S, Sturrock B. Exercise for rotator cuff tendinopathy: a systematic review. Physiotherapy. 2012 Jun;98(2):101-9. doi: 10.1016/j.physio.2011.08.002. Epub 2011 Oct 5. PMID: 22507359.
Lowry V, Lavigne P, Zidarov D, Matifat E, Cormier AA, Desmeules F. A Systematic Review of Clinical Practice Guidelines on the Diagnosis and Management of Various Shoulder Disorders. Arch Phys Med Rehabil. 2024 Feb;105(2):411-426. doi: 10.1016/j.apmr.2023.09.022. Epub 2023 Oct 11. PMID: 37832814.
