Consultancy Corner: Master that shoulder pain

Have you experienced a terrible ache when you lift your arm and rotate it, and wondered what was wrong with it? The cause of this pain is often due to the rotator cuff. It commonly occurs in people beyond 40 years. 

Incidence figures of 0.9-2.5 per cent were found in different age groups. At any given point in time, the prevalence figures differ from 6.9 to 26 per cent. 

The different causes can be anywhere from peri-arthritis (frozen shoulder), impingement (when the tendons of the rotator cuff are inflamed and irritated) or a tear of the cuff. Impingement and rotator cuff tear can be considered as two ends of a spectrum of shoulder disorders affecting the rotator cuff. 

Here are some questions and answers that will help you understand the Rotator Cuff (RC) and its associated pathologies much better. 

The muscles controlling various movements of the shoulder before attaching at the shoulder joint coalesce to form a sheet or cuff like structure known as the rotator cuff. The muscles of the cuff primarily function to stabilise the shoulder joint and to ensure its efficient functioning. The individual muscles also function to move the shoulder in various directions that include elevation, external rotation and internal rotation. The normal functioning of the cuff is ensured by its continuity and integrity as well as by smooth gliding of this sheet in the narrow space of the shoulder joint which in turn is facilitated by lubricating tissues known as the bursa. 

The pathologies of the rotator cuff can range from inflammation (RC tendinitis), degeneration (RC tendinosis) or tear (partial or complete RC tear). There may be a component of each one in any presenting pathology. Inflammation of the cuff leads to swelling, thickening and micro tears in the cuff interfering with its smooth gliding in the narrow space of the shoulder. This causes pain during shoulder movements especially elevation.

RC tears are uncommon in people younger than 40 years unless the cuff is torn with a fragment of bone at its insertion. This usually follows a fall on an outstretched hand or a direct impact on the shoulder. Young patients are more commonly affected with RC tendinitis. Patients older than 40 years, especially those with multiple conditions like diabetes mellitus, gout, smoking, alcohol etc more commonly suffer tears of the RC.

Cases of RC tendinitis or tendinosis can be treated conservatively with anti-inflammatory medications and rest followed by RC strengthening. Some partial thickness RC tears may heal with rest; others need surgery for repair of the torn cuff. A complete tear of RC cannot heal without repair. Some (not all) partial thickness tears of RC may heal with rest. It is advisable for young and active people to get their RC tears assessed by a doctor and repaired early for good results. For those needing surgery, it can be done via open, mini open or arthroscopic approach. Active shoulder movements including overhead movements may be started after 6 weeks of surgery. Routine office work can begin after 2-3 months from surgery. Return to sports is only advisable after 8 – 9 months, provided proper physiotherapy protocol has been followed.