Shoulder pain is big in Singapore. This should come as no surprise – the 2017 GSK Global Pain Index published that over 85% of Singaporeans have suffered from head and body pain. Almost have of Singaporeans live with pain on a weekly basis.
Some of you would suffer from shoulder pain that is coming from the upper trapezius muscle that is commonly associated with neck pain while others may suffer from shoulder symptoms that are coming from the rotator cuff muscles.
What is your rotator cuff?
Your rotator cuff is a group of four muscles – supraspinatus, infraspinatus, subscapularis, and teres minor – that provides stability to your true shoulder joint and also helps with movements of arms.
Your rotator cuff is found directly on and under your shoulder blade with the except of the teres minor which attaches to the edge of the scapula and somewhat slings to your humerus (the big bone in your arm).
Most pathology of the shoulder occur at the subacromial space – somewhere where your collar bone meets the shoulder blade.
How do I know if I have damaged my rotator cuff?
Rotator cuff injury is complex and often contributes to shoulder pain, reduced range of motion in the arm, or pain with certain arm movements.
Overhead activity is usually a challenge. If you find yourself struggling to move your arm overhead (e.g. taking off a shirt, reaching for a heavy item in the cabinet), there is a possibility that you have injured your rotator cuff.
In cases of a tendinopathy of the rotator cuff tendons, you may experience a deep, dull ache at rest.
How do doctors diagnose a torn rotator cuff?
A doctor or orthopaedic surgeon can diagnose rotator cuff injuries through orthopaedic testing or a MRI.
Common orthopaedic testing may include:
- Empty Can Test (or Full Can Test) to assess the function of the supraspinatus muscle
- Dropped Arm Test, also to assess the supraspinatus muscle
- Hawkins-Kennedy Impingement Test to assess the supraspinatus tendon
Positive orthopaedic testing does not mean that you definitely have a rotator cuff pathology.
In fact, an article published in Journal of Orthopaedic & Sports Physical Therapy last year strongly advocated against the use of a specific diagnostic label.
The authors proposed the use of a generic diagnostic term rotator cuff-related shoulder pain to describe a whole range of conditions from subacromial impingement syndrome (also subacromial pain syndrome) to rotator cuff tendinopathy.
Do I need an MRI for shoulder pain?
It sounds counter-intuitive but research tells us it’s not important to know what exactly is going wrong.
It is true that a MRI of your shoulder will likely show a bone spur, some issues with your muscles and tendons. However, these findings correlate very poorly with pain.
A study earlier this year looking at elite volleyball found that 100% of them have abnormal imaging findings on their MR. However, 100% of them are symptom-free!
- Almost 90% showed signs of tendinopathy
- 65% had rotator cuff tears
- Over 20% were found to have labral tears
- Despite all the findings, these athletes are 100% pain-free!
This is why the current clinical consensus is to avoid imaging – MRIs, x-rays – a shoulder joint at the first sign of shoulder pain.
Shoulder pain can be difficult to diagnose and complex to manage
This is not to say that your shoulder problems are an non-issue.
If you have been living with shoulder pain for a while and tried a range of treatments to no results, you are not alone:
- Professional basketballer Kyrie Irving is struggling to recover from his shoulder pain despite receiving a cortisone injection last year. He missed 26 games earlier this season because of his shoulder problems
- Professional baseball player Aaron Judge also suffers from a shoulder pain that medical doctors are still unable to diagnose
Here is the good news for you: Most of us do not use our shoulder muscle in the same capacity as professional athletes.
With an evidence-based approach, you should be able to return to doing what you love without pain in no time.
How do you treat a rotator cuff injury?
A consensus statement published in Physiotherapy Practice and Research found physical therapists agreeing that:
- Exercises should be prescribed to address shoulder function of the patient for at least 12 weeks.
- Imaging was determined to be not useful
- Steroid injections (cortisone), the treatment received by Kyrie Irving, is also considered to be not helpful
Shoulder pain exercise for a rotator cuff injury?!
Most people scoff when they hear exercise as a solution for their pain or injury. Research tells us that exercise performs as well – or even outperform – surgery when it comes to to shoulder pain.
A looking at 452 patients published that rehabilitation is effective for FULL thickness tears in 75 of the patients. Yes, you heard that right – full thickness tears.
If you have been living with shoulder pain for a while now and you suspect you have a rotator cuff injury, do get it assessed by a professional chiropractor or physiotherapist.
If you have been trying predominantly ‘hands on’ treatment (e.g. chiropractic adjustments, dry needling, IASTM) with little to no results, it’s perhaps time to consider exercise.
Quite often I hear prospective clients telling me that they already exercise or they have already tried exercise. However, in most of these instances, it’s self-directed without professional advice. I have written about why following YouTube videos or Instagram exercises are unlikely to deliver good recovery outcomes.
It may seem the same but it is not.
Take for example, would an amateur homemade bread be as good as one done by a professional baker?
If you have painted your own room or walls, you’d know how difficult it is to get it an even coating of paint. Sure, it does sound like an easy job but yet at a same time a professional almost always does it better.
To find out what we do to help you find freedom with shoulder pain and discover the difference the right care can make, book in an appointment with us with the form below.