FAQs

Shoulder Impingement Syndrome

Your Shoulder Impingement Zone is where your shoulder tendons and bursa are most likely to impinge against the (acromion) top of the shoulder blade during overhead or shoulder height movement. The shoulder impingement zone is the most likely area when injuries to your rotator cuff or shoulder bursa occur due to the narrowing of the sub-acromial (space below the acromion) during this shoulder position.

Postures that significantly narrow the sub-acromial space are:

• Rounded shoulder postures.
• Your arm is working at or near shoulder height.
• Your arm is high overhead.
• Poor scapulohumeral rhythm.

Injuries that result fall under the Shoulder Impingement Syndrome group of injuries. These include shoulder bursitis and rotator cuff injuries.

Who Suffers Shoulder Impingement Syndrome?

Shoulder Impingement Syndrome is more likely to occur in people who engage in physical activities that require repeated overhead arm movements, such as tennis, golf, swimming, water polo, weight lifting, or throwing a ball. Occupations that require repeated overhead lifting or work at or above shoulder height are also at risk of rotator cuff impingement.

What are the Symptoms of Shoulder Rotator Cuff Impingement?

Commonly rotator cuff impingement has the following symptoms:

• An arc of shoulder pain occurs approximately when your arm is at shoulder height or when your arm is overhead.
• Shoulder pain can extend from the top of the shoulder to the elbow.
• Pain when lying on the sore shoulder.
• Shoulder pain at rest as your condition deteriorates.
• Muscle weakness or pain when attempting to reach or lift.
• Pain when putting your hand behind your back or head.
• Pain reaching for the seatbelt.

How is Shoulder Impingement Syndrome Diagnosed?

A thorough clinical examination will identify a rotator cuff impingement in most cases. Your physiotherapist will ask about your shoulder pain and its behaviour and examine your shoulder with specific tests that identify impingement signs.

Diagnostic tests may include MRI or diagnostic ultrasound scans to look for rotator cuff tears, shoulder bursitis, or impingement signs.

A problem with your neck joints can commonly cause shoulder pain. Your physiotherapist will examine this area to rule out this cause or include its treatment in your care plan.

For specific shoulder impingement advice, please consult your shoulder physiotherapist.

More info: Shoulder Injuries

What is Your Rotator Cuff?

Rotator cuff syndrome is a prevalent shoulder injury that involves a group of four muscles known as the rotator cuff. These muscles, including the subscapularis, supraspinatus, infraspinatus, and teres minor, surround the head of the humerus (shoulder ball) and are responsible for shoulder rotation, stability, and control.

The rotator cuff muscles are crucial in holding the arm (humerus) onto the shoulder blade (scapula) and stabilising the shoulder joint. They work together to enable various shoulder movements while ensuring proper function and stability. However, the tendons of the rotator cuff can be susceptible to injuries such as tears, tendonitis, impingement, and related conditions.

Rotator Cuff Injuries

Injuries to the rotator cuff can range in severity from mild cases of soft tissue pinching and inflammation (shoulder impingement and bursitis) to more severe damage like calcific tendinopathy, or rotator cuff tears.

Each condition requires specific management and treatment approaches tailored to the individual's needs.

Rotator Cuff Treatment

Treatment for rotator cuff injuries typically involves physiotherapy, which focuses on addressing the underlying movement issues and avoiding positions that cause impingement or aggravate symptoms. This approach helps manage pain in the short term and prevent further damage or recurrent bursitis. Full-thickness rotator cuff tears may require surgical repair and extensive post-operative physiotherapy rehabilitation.

Conclusion

In conclusion, the rotator cuff is vital in shoulder stability and movement. The four muscles that make up the rotator cuff work together to ensure proper shoulder joint function. However, these muscles and tendons are prone to various injuries, ranging from mild inflammation to more severe tears or ruptures. Fortunately, many rotator cuff injuries can be effectively treated with physiotherapy, which focuses on addressing movement issues and preventing further damage. In more severe cases, surgical intervention may be necessary. Understanding the importance of the rotator cuff and promptly seeking appropriate treatment can help individuals recover from these injuries and regain optimal shoulder function.

Please contact your trusted shoulder physiotherapist or doctor for specific advice.

How Can a Cortisone Injection Aid a Torn Rotator Cuff?

What is Your Rotator Cuff?

Your rotator cuff, a vital component of your shoulder, consists of four muscles and tendons. This complex enables arm movement in various directions and stabilises the shoulder by securing the humerus head in the glenoid socket.

Tackling Rotator Cuff Tears

Rotator cuff tears, occurring either suddenly or over time, lead to shoulder pain and impaired function. Research consistently endorses physiotherapy and exercise rehabilitation as primary, effective treatments for these injuries.

The Role of Cortisone Injections

When conventional treatments like physiotherapy, medication and rest don't alleviate pain from a rotator cuff injury, your healthcare team, including your physiotherapist or doctor, may suggest a cortisone injection. This treatment, combining hydrocortisone and a local anaesthetic, aims to lessen inflammation and pain. It's crucial to identify the injection's target: is it a shoulder bursa or the tendon?

Weighing the Benefits and Risks of Cortisone Injections

While effective in treating conditions like shoulder bursitis, cortisone injections also pose risks. Research indicates that repeated injections, particularly in or near tendons, may weaken the tendons and impair tissue repair. This risk could even heighten the likelihood of future tendon tears.

Steroid Injections and Rotator Cuff Tendon Tears

Lin et at 2022 studied 1025 patients and found a positive correlation between steroid injections and cuff tendon tears. Steroid injections on the shoulder were associated with a raised risk of cuff tendon tears by 7.44 times compared to non-injection.

Consequently, healthcare professionals typically recommend at least 4-6 weeks of rehabilitation prior to considering injections. Tendon injections are highly discouraged, while injecting an inflamed bursa under ultrasound guidance may provide quick pain relief without compromising tendon integrity. (ElMeligie et al 2023)

Post-Injection Rehabilitation: Enhancing Recovery

Following a cortisone injection, many patients experience significant improvements in shoulder pain and function. These benefits are often maximised when combined with a tailored exercise rehabilitation program.

The Initial Rest Period

After receiving a cortisone injection, it's advisable for patients to rest for approximately one week. This rest period is crucial to allow the injection site to heal and for the cortisone to take full effect before beginning rehabilitation exercises.

Recent Research Insights

Emerging studies emphasise the significance of structured rehabilitation post-cortisone injection, enhancing shoulder function and pain management. These findings highlight the essential role of physiotherapists in creating and overseeing these rehabilitation programs.

Addressing the Underlying Cause

A key aspect often overlooked in rehabilitation is identifying and addressing the root cause of the injury. For instance, if a rotator cuff tear or bursitis was triggered by shoulder impingement, it's vital to correct the movement patterns that led to this issue. Simply treating the symptoms without understanding the cause may lead to recurrent problems.

The Role of Physiotherapy in Shoulder Biomechanics

Knowledge in shoulder movement biomechanics is a cornerstone of physiotherapy. A skilled shoulder physiotherapist can not only assess but also correct improper shoulder movements. Seeking their advice is critical in preventing recurring instances of shoulder bursitis or more severe injuries like rotator cuff tears.

Consultation and Ongoing Care

We strongly recommend consulting with a physiotherapist for a comprehensive assessment and a customised rehabilitation plan. Their guidance will be instrumental in ensuring a full and sustainable recovery, preventing future complications related to shoulder injuries.

Conclusion: Finding the Right Balance

Cortisone injections can offer substantial relief for those with shoulder bursitis and rotator cuff injuries, particularly when physiotherapy and exercise rehab alone don't suffice. However, it's imperative to consider both the benefits and risks, particularly regarding tendon health.

Seeking Professional Advice

If you're struggling with shoulder pain or suspect a rotator cuff injury, consult a qualified physiotherapist or your doctor. They can accurately diagnose your condition and suggest the most suitable treatment plan, possibly including a cortisone injection and follow-up rehab. For professional guidance and care, contact our team at PhysioWorks.

More info:

• Rotator Cuff Injury
• Rotator Cuff Tears
• Shoulder Bursitis
• Shoulder Impingement 
• Shoulder Pain FAQs & Products

How to Identify a Torn Rotator Cuff and Seek Proper Treatment

Suppose you're experiencing shoulder pain that disrupts your sleep and leaves you wondering whether you have torn your rotator cuff. In that case, it's crucial to understand the signs and seek appropriate care. This article will discuss the two types of rotator cuff tears and guide in identifying them. Additionally, it emphasises the importance of early physiotherapy support and referral to a shoulder specialist when necessary.

Types of Rotator Cuff Tears

There are two main types of rotator cuff tears: traumatic and atraumatic.

Traumatic Tears

A traumatic tear occurs when you injure your shoulder due to a specific, memorable, and forceful event. Examples include falling onto your arm or experiencing a shoulder dislocation. Signs of a traumatic tear may include intense pain, sleep interruption, and limited arm movement, particularly when lifting or rotating it away from your body.

Atraumatic Tears

An atraumatic tear occurs without recollection of a significant force or injury. These tears often result from repetitive microtraumas, where the cumulative effect of multiple low threshold forces exceeds your shoulder's capacity. It's possible to tear your rotator cuff from a seemingly innocuous activity you perform regularly. Symptoms of an atraumatic tear are similar to those of a traumatic tear. They may include pain, disrupted sleep, inability to lay on your shoulder at night, and difficulty moving your arm. In these cases, changes to the rotator cuff tendons often occur before the onset of symptoms.

Management and Seeking Treatment

The management of rotator cuff tears depends on factors such as tear size, the nature of the injury, and your shoulder's functionality. If you experience any of the following symptoms, it is advisable to seek physiotherapy support promptly:

1. Constant pain disrupts your sleep.
2. Inability to move your arm effectively.

Physiotherapy can provide valuable assistance in recovery, and some tears may necessitate referral to a shoulder specialist. At your local PhysioWorks, experienced physiotherapists offer same-day appointments and help you on your path to recovery.

Conclusion

Identifying a torn rotator cuff requires careful consideration of the type of tear and associated symptoms. Whether the tear is traumatic or atraumatic, seeking appropriate treatment early to prevent further complications is crucial. Physiotherapy support and potential referral to a shoulder specialist can significantly aid in your recovery. Early intervention is vital to restoring your shoulder's health and functionality.

For additional information on rotator cuff tears, please refer to:

• Rotator Cuff Tears
• Shoulder Pain FAQs & Products

Diagnosing a Torn Rotator Cuff: Beyond the MRI

Diagnosing a torn rotator cuff can be challenging, but it is not solely reliant on MRI scans. While MRI is considered, there are alternative methods that can provide valuable insights into this common shoulder injury. This article explores various diagnostic approaches beyond MRI. It emphasises the importance of a comprehensive assessment by a skilled physiotherapist or doctor.

Physical Examination and Patient History

A thorough physical examination and detailed patient history can often yield valuable information when diagnosing a torn rotator cuff. Skilled healthcare professionals can assess symptoms, such as pain, weakness, limited range of motion, and abnormal shoulder movements. By carefully analyzing these indicators, they can develop a preliminary understanding of the presence and severity of a rotator cuff injury.

In addition to a physical examination, specific physical tests can help determine if a torn rotator cuff is likely. Healthcare providers may employ a variety of tests, such as the drop arm test, the empty can test, and the external rotation lag sign. These tests evaluate the rotator cuff tendons' integrity and associated muscles, providing further evidence of a tear.

High-Resolution Diagnostic Ultrasound

When a rotator cuff tear is suspected, high-resolution diagnostic ultrasound is a valuable imaging tool. Research has demonstrated that ultrasound can be more specific, sensitive, and cost-effective than MRI. This non-invasive technique allows healthcare professionals to visualize the rotator cuff tendons, assess the extent of the tear, and identify any associated abnormalities.

X-rays

X-rays are generally not helpful in diagnosing rotator cuff tears directly. However, they can be crucial in ruling out other potential causes of shoulder symptoms, such as fractures, arthritis, or bone spurs. These also highlight bone spurs that may be the cause of your rotator cuff tear.

Magnetic Resonance Imaging (MRI)

While alternative methods can be effective, MRI remains a diagnostic tool for assessing a torn rotator cuff. MRI provides detailed images of the shoulder joint, including the rotator cuff tendons, muscles, and surrounding structures. This imaging modality is beneficial when planning surgical interventions or in cases where other diagnostic methods are inconclusive.

Conclusion

While MRI is a method for diagnosing a torn rotator cuff, it is not the only option available. They can be expensive and have been known to miss some tears. A combination of physical examination, patient history, physical tests, and imaging techniques like high-resolution diagnostic ultrasound and, when necessary, MRI can help healthcare professionals accurately assess and diagnose rotator cuff tears. By employing these comprehensive approaches, appropriate treatment plans, whether surgical or non-surgical, can be developed to address this common shoulder injury effectively.

Related Articles

• Rotator Cuff Tears
• Shoulder Pain FAQs & Products

What You Need to Know About Lifting Your Arm with a Rotator Cuff Tear

Common Shoulder Pain Results from a Rotator Cuff Tear

Experiencing a rotator cuff tear can lead to questions about your ability to lift your arm. Whether you can still perform this action depends on several factors, including the injury's severity, the specific muscle affected, and the pain level you feel. Let's discuss these factors in detail.

Severity of Rotator Cuff Tear

Partial Tear vs. Full-Thickness Tear

The severity of your rotator cuff tear significantly affects your arm movement. With a partial tear, you may feel pain but still manage some arm movement. In contrast, a full-thickness tear can make lifting your arm extremely challenging or even impossible due to the complete disruption of muscle function.

Related Articles:

1. Rotator Cuff Injuries - Discusses the different types of rotator cuff injuries and their treatments.
2. Shoulder Pain Management - Offers insights into managing shoulder pain effectively.
3. Physiotherapy for Shoulder Injuries - Explains how physiotherapy can aid in the recovery of shoulder injuries.

Affected Area of the Rotator Cuff

Muscle-Specific Impact

The rotator cuff consists of four muscles, each responsible for different shoulder movements. The specific muscle injured will determine the degree of functional impairment and the direction in which you can move your arm. Identifying which muscle is affected helps in understanding the limitations and planning the appropriate treatment.

Pain Level and Arm Mobility

Pain Management

Pain is a critical factor in your ability to lift your arm. Severe pain can prevent movement, leading to further complications. Effective pain management strategies are essential for maintaining arm function. Physiotherapists can offer various techniques to help manage pain, allowing for better movement and recovery.

Seeking Professional Guidance

Consulting a Physiotherapist or Doctor

For tailored advice and effective treatment, consulting a qualified shoulder physiotherapist or doctor is crucial. They can provide a detailed assessment and develop a personalised treatment plan, considering your specific condition and needs. Physiotherapy often includes exercises and modalities that aid in recovery and pain management.

Conclusion

Understanding the impact of a rotator cuff tear on your arm movement is essential for effective recovery. By exploring professional advice and treatments available, you can manage your condition better and work towards regaining full functionality.

What to Do?

If you suspect a rotator cuff tear, seeking professional advice from a physiotherapist or doctor is vital. They can guide you through diagnosis, treatment options, and recovery plans, helping you achieve the best possible outcome.

Rotator Cuff Tear FAQs

1. Can you lift your arm with a rotator cuff tear?
   • It depends on the tear's severity. Partial tears may allow some movement, but full-thickness tears can make lifting your arm very difficult.
2. What are the symptoms of a rotator cuff tear?
   • Common symptoms include shoulder pain, weakness, and limited range of motion. Pain may increase when lifting your arm.
3. How is a rotator cuff tear diagnosed?
   • A doctor  or physiotherapist may use physical exams, imaging tests like MRI or ultrasound, and your medical history to diagnose a rotator cuff tear.
4. What are the treatment options for a rotator cuff tear?
   • Treatments range from physiotherapy and medications to injections and, in severe cases, surgery.
5. Can a rotator cuff tear heal without surgery?
   • Many partial tears can heal with non-surgical treatments, but full-thickness tears often require surgery for optimal recovery.
6. How long does it take to recover from a rotator cuff tear?
   • Recovery time varies; non-surgical treatment can take weeks or several months, while surgical recovery can take up to a year.

Related Articles

1. Rotator Cuff Injuries
   • Discover different rotator cuff injuries and their treatments.
2. Shoulder Pain Management
   • Learn effective ways to manage shoulder pain.
3. Physiotherapy for Shoulder Injuries
   • Explore how physiotherapy helps with shoulder injury recovery.
4. Chronic Pain Management
   • Strategies for managing chronic pain conditions.
5. Shoulder Impingement
   • Understand shoulder impingement and treatment options.
6. Frozen Shoulder
   • Discover the causes and treatments for frozen shoulder.
7. Post-Surgery Shoulder Rehabilitation
   • Learn about the rehabilitation process after shoulder surgery.
8. Shoulder Stability Exercises
   • Exercises to improve shoulder stability and function.
9. Sports Injury Rehabilitation
   • Effective strategies for recovering from sports-related injuries.
10. Shoulder Pain Relief Techniques
    • Various techniques to manage and relieve pain effectively.

How to Speed up Rotator Cuff Healing

Rotator cuff injuries can be a common source of shoulder pain, but you can promote faster healing with the right approach. Here are some tips to help speed up the healing process for your rotator cuff:

Avoid Sleeping on Your Affected Side

Compression is detrimental to tendon healing, and the rotator cuff is particularly susceptible due to its anatomical structure. When you sleep on the affected side, the tendon gets compressed from both sides, hindering the healing process. It's best to sleep on the unaffected side, keeping your arm slightly away from your body and avoiding any rotation that strains the other cuff muscles. Changing your sleep position can be challenging, but you can use pain relief or ice before bedtime to ease discomfort.

Ice Therapy

Ice can be beneficial in reducing inflammation and preventing abnormal blood vessel formation in the tendon. Studies have shown that shoulder tendons with new blood vessels (neovessels) are more prone to experiencing pain. Applying ice for 20 minutes multiple times daily, with at least 45 minutes between sessions, can help manage inflammation and promote healing.

Seek Professional Guidance

Every rotator cuff injury is unique, and it's crucial to consult a shoulder physiotherapist or doctor for personalised advice. They can assess your condition, provide tailored exercises, and guide you throughout healing. Their expertise will ensure you take the proper steps and avoid potential setbacks.

Find Your Appropriate Load Level

Most rotator cuff injuries result from repetitive overuse. Continuing to strain these muscles at the same intensity can delay healing. However, complete rest is not the solution either. You need to provide an appropriate load to stimulate tissue remodelling and healing. Start with a short rest period, then gradually introduce gentle exercises recommended by a health professional, such as a shoulder physiotherapist. Identifying the causative factors and respecting pain are essential in determining the right load level for your injury.

Conclusion

In conclusion, it's vital to approach rotator cuff injuries with patience and a comprehensive healing plan. You can accelerate the healing process by implementing the tips mentioned above, such as finding your appropriate load level, avoiding sleeping on the affected side, and using ice therapy. However, seeking professional guidance from a trusted shoulder physiotherapist or doctor who can provide personalised advice based on your specific condition is essential. They will guide you through appropriate exercises and ensure you take the necessary steps to recover successfully.

Remember, healing takes time, but with the right approach and expert support, you can regain strength and return to normal activities as soon as possible.

More info:

• Rotator Cuff Syndrome
• Shoulder Pain FAQs & Products

References

Naunton J, Harrison C, Britt H, Haines T, Malliaras P (2020) General practice management of rotator cuff related shoulder pain: A reliance on ultrasound and injection guided care. PLOS ONE 15(1): e0227688. https://doi.org/10.1371/journal.pone.0227688

Skazalski, C, Bahr, R, Whiteley, R. Shoulder complaints more likely in volleyball players with a thickened bursa or supraspinatus tendon neovessels. Scand. J. Med. Sci. Sports. 2021; 31: 480– 488. https://doi.org/10.1111/sms.13831

Khan, K. M., Cook, J. L., Taunton, J. E., & Bonar, F. Overuse Tendinosis, Not Tendinitis. The Physician and Sportsmedicine, 28(5), 38–48. doi:10.3810/psm.2000.05.890

How Can I Get Rid Of Plantar Fasciitis?

The management of plantar fasciitis requires treatment of what contributed to its development in the first place. Reducing these may be necessary if there was a recent increase in physical activity or standing time. From an exercise perspective, this may mean less time spent doing weight-bearing tasks, and if it is work-related, then breaking up periods of standing with intermittent sitting can be worthwhile. If limited ankle movement contributes to your symptoms, stretches can be effective, particularly for the calf and foot muscles. Beyond these strategies, there is good evidence for hands-on, soft tissue treatment of the plantar fascia and surrounding structures, taping the foot, and prescribing orthoses. Strength and movement training exercises can also be effective.

Physiotherapies are skilled in assessing and managing foot conditions, so call or book an appointment online today!

More info: Plantar Fasciitis