In the clinic, I often have a client who brings in a referral that reads "right shoulder rotator cuff tendinitis/tendinosis". And over 90% of these individuals when asked which muscle (I'll get to this in a bit) was injured, I get the blank stare. The rotator cuff is a group of 4 muscles that contribute significantly to the stability of the shoulder, meaning the reason your arm isn't hanging out of its socket is because the rotator cuff is doing its job. The 4 muscles are supraspinatus, infraspinatus, teres minor, and subscapularis. Each muscle has a primary role it does on its own, but offers assistance to other muscles as well. Therefore, even though one muscle may be affected, a client will often have other issues going on. This is typically why injections, which are helpful initially to reduce pain symptoms, are short-lived.
However, often times our repetitive overhead motions or poor posture (slumped positions, forward shoulders) provide for less than optimal space in the subacromial space. This leads to irritation of the tendons which produces the pain experienced with certain motions.
Well, the tendons of the rotator cuff, particularly the supraspinatus, do not have a lot of blood supply. Less blood supply = less nutrients = slow healing times. Couple this with continuation of activities that aggravate the tendon and you find yourself months (sometimes longer) of progressive worsening pain. One of the recommendations I would strongly encourage is during the early stages of rehabilitation a client avoid aggravating activities to assist the healing process.
An X-ray shows bones, so if you believe you have a rotator cuff issue, asking for an X-ray is like asking for an alignment check on your car when you really needed your brakes looked at. An MRI can confirm or rule out a rotator cuff problem (including a tear), and is usually very specific about which of the four muscles are involved. However, as a PT, I can perform tests in the clinic on each individual rotator cuff muscle and it would be at a fraction of the cost an MRI would be. If a tear is suspected, I may recommend an MRI to determine if a surgical procedure is warranted.
A PT will listen for certain symptoms during their interview with a client. For example, when someone tells me they have shoulder pain at night when they roll onto the affected shoulder, along with pain while reaching for something at certain angles, I already know right there I want to rule in/out a rotator cuff problem. After I perform thorough clinical testing that involves examining each individual muscle, I can advise you at what stage of your injury you are at and what to do. For example someone who has high pain levels, possesses some tenderness and warmth to touch, and isn't able to lift their arm will warrant different recommendations than someone who has very little to no pain, no tenderness, and just slight weakness.
The take home message: Consider visiting with a PT prior to an expensive MRI or getting surgery. We just might be the stabilizing force your shoulder needs!
Patrick Toy, DPT (Kent/Des Moines)
AT HIGHLINE PHYSICAL THERAPY, WE STRIVE TO EDUCATE OUR CLIENTS ABOUT THEIR CONDITION SO THEY MAKE THE BEST HEALTHCARE CHOICES FOR THEMSELVES. OUR THERAPISTS ARE COMMITTED TO ENSURING WE EARN YOUR TRUST BECAUSE WE VALUE THE OPPORTUNITY TO GETTING YOU "BACK TO FUNCTION, BACK TO LIFE."