Rotator Cuff Injuries and Shoulder Pain
Rotator cuff injuries are very common, especially in people over 40 years of age. Most problems involve damage and irritation to the rotator cuff soft tissues (muscles, ligaments, tendons and bursa) rather than the bones, as they move frequently within a tight space.
A rotator cuff injury usually begins as inflammation caused by some form of small but continuous source of irritation, such as repetitive overhead motions from sporting activities, work tasks or daily chores, which can lead to tendonitis, tendinosis, frozen shoulder, impingement, or bursitis.
If you do not address the cause of the inflammation, a partial or complete tear (rupture) can develop in your rotator cuff due to chronic wear and tear of the tendon. A tear may also result at any age from an acute or single traumatic event, such as a fall onto an outstretched arm.
The shoulder has the widest range of motion of any joint in the body. To allow for this incredible range, it is made up of many complex parts which means that it is also injured easily. The shoulder joint can easily slip out of alignment by a few millimeters, become weak due to regular wear and tear, or become completely dislocated during a fall.
The point where the upper bone (humerus) of the arm meets the shoulder (scapula and acromion process) is called the rotator cuff. The rotator cuff is the most vulnerable part of the shoulder and is where most shoulder injuries occur. To better understand what is happening inside your rotator cuff it is helpful to understand the different parts of the shoulder.
What is the Rotator Cuff?
The rotator cuff muscles are connected individually to a group of flat tendons, which fuse together and surround the front, the back, and the top of the shoulder joint like a cuff on a shirt. The tendons attach the muscles to the bone and allow movement in the shoulder, as well as providing strength to hold the ball in its socket. They are involved in all shoulder motions: when the muscles contract, they pull on the rotator cuff tendon, causing the shoulder to rotate upward, inward, or outward, hence the name rotator cuff.
The rotator cuff ligaments attach bone to bone and provide stability to the shoulder joint bones. Between the bones, muscle and other soft tissue there are several bursae (fluid filled sacs) and synovial fluid (lubricates your joint) that permit smooth gliding wihtin the joint. They also protect the rotator cuff from the bony parts of the shoulder blade.
The Shoulder Joint
Inside the shoulder there are three joints; the glenohumeral joint, the acromioclavicular joint (A/C joint) and the sternoclavicular joint.
The glenohumeral joint is a joint where the greater tubercle (humeral head at the top of the arm bone) meets the shoulder socket of the scapula, called the glenoid cavity or glenoid fossa. Inside the joint, the labrum (a form of cartilage) cushions the humeral head against the glenoid.
This joint is considered a ball and socket joint however the 'socket' is not as deep as similar joints in your body. Instead, the humerus sits against the glenoid cavity similar to how a golf ball sits on a tee. Since the ball does not fit directly inside socket of the glenohumeral joint, it is the labrum, muscles, and tendons that hold the ball of the humerus against the glenoid fossa providing stability between your scapula and your humerus.
Due to this shallow socket and the scapula 'floating' above the rib cage (connected to the clavicle by ligaments, muscles and tendons) your shoulder is able to move around freely in several directions. This makes the shoulder the most mobile joint in the body. However, this also makes it the least stable joint and the one most prone to injury.
The acromioclavicular joint (A/C joint) is a gliding joint between the clavicle and the acromion. The acromion is a bony projection that comes off the scapula and forms the point at the outside edge of your shoulder. The acromioclavicular joint allows you to rise your arm over your head. If this joint dislocates it is commonly known as a separated shoulder.
The sternoclavicular joint, where the collar bone meets the sternum (breast bone) is not considered as important for shoulder movement.
Rotator Cuff Tendons and Muscles
Although many people refer to the rotator cuff as a general area in the shoulder, your rotator cuff itself is a group of 4 tendons located at the top of your humerus. These tendons are called the subscapularis tendon, the supraspinatus tendon, the infraspinatus tendon, and the teres minor tendon.
These tendons come together to surround the front, back, and the top of the shoulder socket acting as a 'cuff' to connect your humerus to the rotator cuff muscles. When you contract the attached muscles (subscapularis muscle, the supraspinatus muscle, the infraspinatus muscle, and the teres minor muscle), they pull on the tendons causing the shoulder to rotate up or down, back or front, in or out; hence the name 'rotator' cuff.
These muscles, along with the teres major and the deltoid, keep the shoulder's ball and socket joint firmly in place and are responsible for stabilizing the shoulder. These muscles work together as a unit rather than individually.
As a result, rotator cuff injuries usually involve more than one of these muscles or tendons. If any of the 4 main rotator cuff tendons or muscles become injured it will greatly affect the stability of shoulder.
The supraspinatus is the most frequently torn of all the rotator cuff tendons. It is the uppermost muscle of the rotator cuff and is located at the back of your shoulder blade. It passes beneath the acromion and runs towards the greater tubercle at the top of your humerus joining at the top of the cuff by the supraspinatus tendon. Your supraspinatus muscle primarily helps you to bring your arm directly out to the side(known as abduction) although it assists you with other shoulder motions as well.
The subscapularis is the largest and the strongest of all your rotator cuff muscles. It completely covers the front of the shoulder blade. This muscle is attached to the front of the humerus which allows you to move your upper arm inward toward the center of your body (known as internal rotation).
The infraspinatus muscle is located at the back running from the bottom of the shoulder blade across to the top of the humerus. This muscle works with the teres minor muscle to move your arm outward, away from the center of your body (known as external rotation).
The teres minor muscle sits below the infraspinatus and runs at the same angle attaching just below the greater tubercle of your humerus bone. The teres minor also assists with the outward rotation of your arm from the center of your body (know as external rotation).
Other main muscles in the shoulder area include:
- the deltoids
- the subclavius
- the trapezius
- the teres major
- serratus anterior
- pectoralis minor
- levator scapulae
Shoulder Bones and Ligaments
The bone structures inside the shoulder that are significant to the rotator cuff include the humerus, the scapula, the acromion process, the clavicle, the greater tubercle, and the glenoid cavity.
The humerus (upper arm bone) runs from your elbow to your shoulder and meets at the rotator cuff with a ball-like end known as the greater tubercle. This is the 'ball' part of the ball and socket joint in your shoulder.
The scapula (shoulder blade) is a triangular shaped bone with 2 bony projections at the top, right at your shoulder cuff. One of these projections is referred to as the acromion and it sits above the humerus. The other is called the coracoid process and it sits in front of the acromion and below the clavicle. Where your humerus meets your scapula there is a very shallow concave 'socket' known as the glenoid cavity (also called the glenoid fossa).
Ligaments are soft tissue bands that connect one bone to another. The joints of the shoulder that are primarily responsible for movement are held together by several strong ligaments. They include the coracoclavicular ligaments, the coracoacromial ligaments, the superior transverse scapular ligament, the coracohumeral ligament, the acromioclavicular ligament, and the glenohumeral ligaments.
Bursae in the Shoulder
In your shoulder joint there are 4 main bursae; the subacromial bursa, the subcoracoid bursa, the subscapular bursa, and the subdeltoid bursa.
Bursae (plural for bursa) are fluid filled sacs that act as cushions to help the bones and soft tissue move smoothly within the joint. Your bursae also act as padding to protect your soft tissue from the bony points on the scapula, coracoid, and acromion.
The subacromial bursa is the most susceptible to bursitis in the shoulder. It's located in the subacromial space, between the acromion and the humeral head (greater tubercle), and is used frequently during shoulder movement to reduce friction. The risk of impingement of this bursa in the subacromial space is high because the area is small.
Rotator Cuff Treatments
Your initial treatment should involve decreasing any swelling, relieving any pain and stress on the rotator cuff, correcting any biomechanical dysfunction, and then restoring strength and mobility to your injured shoulder. It's also very important to follow any instructions you receive from your physician.
Allowing your shoulder to rest is recommended following injury, however, some careful shoulder movement is required to prevent the joint from freezing and losing range of motion. See your doctor or physical therapist for stretches that will not cause further injury to your rotator cuff. Avoid activities that may have caused the injury or irritation and begin cold compression treatments as soon as possible.
The trick to healing your rotator cuff injury and getting your shoulder back in the best possible condition you can is getting it to heal quickly so there is minimal scar tissue. Even with optimum healing, there is always less elasticity in previously injured rotator cuff tendons, muscles and ligaments. However, if you heal your tissue properly, your chance of re-injury or chronic shoulder conditions later on is much lower than average.
There are healing tools that can help treat your rotator cuff tendon, bursa, or other soft tissue and speed up the healing process so you can get back to a life without pain and risk of further injury. Blood Flow Stimulation Therapy™ (BFST®) will promote blood flow to heal your tendons faster and more completely than any other methods available.
Although steroid injections may provide temporary relief from the pain of rotator cuff tendinitis, bursitis, and other injury they should
generally be avoided as they weaken the tendon and may lead to a rupture. If you do opt for an injection, doctors usually recommend that you do not participate in strenuous activities for several weeks to reduce the risk of a rupture.
Freezie Wrap® ColdCure Technology®
To decrease inflammation and relieve pain for a chronic or diagnosed rotator cuff injury doctor's recommend cold compression therapy. For an acute trauma, cold compression therapy within the first 48 - 72 hours and after any strain or re-injury is important to limit the amount of damage done to your tissue. For chronic pain, cold compression therapy will relieve pain and swelling as needed and will reduce, or even eliminate, the need for NSAIDs.
The Shoulder Freezie Wrap® is the cold compression tool you need treat your supraspinatus tendon, subacromial bursa, and other shoulder tissue in an effective and convenient way.
Cold Compression Therapy works by interrupting and slowing nerve and cell function in the injured area and reducing swelling that can block blood vessels. This is important because once blood vessels are blocked or damaged, they can no longer carry oxygenated blood through your tendon and tissue cells begin to break-down. Without cold compression therapy cellular break-down and tissue damage continues as the cells do not get the oxygen they need to survive. By limiting the amount of damage done to your tissue, you also limit the amount of healing that needs to occur. This is a very important step to healyour injured tendon, bursa, muscle, labrum, or ligaments faster and with less pain!
The deep cooling effect provided by the Shoulder Freezie Wrap® slows cell metabolism thereby reducing cellular break-down and tissue damage. Furthermore, because the cold wraps gently numb the nerves, the wraps also reduce pain! The Shoulder Freezie Wrap® uses a supercharged cooling gel pack, that chills in the fridge, not in the freezer like ice or other freezer packs, giving you deep cold therapy without the risk of 'cold burns' or cryoburn. The medical-grade wrap keeps the cold directly off your skin preventing cryoburn while delivering cold right where you need it.
Inferno Wrap® Blood Flow Stimulation Therapy™
After severe inflammation and swelling is reduced you can begin to treat your rotator cuff tendon, bursa, labrum and other soft tissue with Blood Flow Stimulation Therapy™ (BFST®). BFST® increases the amount of blood that flows naturally to your shoulder to nourish your tendons, ligaments and muscles to speed healing.
The rotator cuff naturally receives a limited blood supply and when you stop moving your shoulder because it hurts the blood flow is reduced even further, limiting your body's natural ability to heal itself.
By treating your rotator cuff with BFST® you can increase your body's blood supply to the shoulder and increase your body's natural healing power.
An Inferno Wrap® is the tool you need to treat your sore shoulder because it speeds healing and relaxes the surrounding muscles. With BFST®, tissues are safely and gently stimulated. Your body responds with a rapid increase in blood flow to the area, increasing the supply of oxygen and nutrients to injured cells to promote healing. Our Shoulder Inferno Wrap® provides effective, non-invasive, non-addictive pain relief and healing with no side effects.
In addition, the improved blood flow whisks away dead cells and toxins that have built up from the injury. When you stop moving your arm and shoulder due to shoulder pain, your muscles and other tissue can become weaker and dead cells and toxins in the area can cause further tissue deterioration - this can lead to atrophy. By clearing the area of toxins and increasing the amount of oxygen and nutrients to your muscle and other tissue, the risk of atrophy (muscle weakness and/or deterioration) is greatly reduced. Keeping your upper arm, shoulder and rotator cuff tissue as healthy as possible throughout the healing process will allow you to improve shoulder strength again once your pain has gone and your injury has healed.
Click here to learn more about how BFST® and Inferno Wraps® work.
With these easy-to-use, home therapies, cold compression and BFST®, you will notice significantly reduced pain and an incredible improvement in your rotator cuff range of motion.
During your recovery, you may have to modify and/or eliminate any activities that cause pain or discomfort in your rotator cuff area until your pain and inflammation settle, and you gain more mobility and strength in your shoulder. The more diligent you are with your treatment and rehabilitation, the faster you will see successful results!
Remember: We recommend that you consult your doctor and/or physiotherapist before using any of our outstanding products, to make sure they're right for you and your condition.
Physical therapy is a beneficial way to help decrease pain in the soft tissues, restore atrophied muscles and improve shoulder strength and mobility. The type of physical therapy and the duration will be dependent on your injury.
Once your pain starts to diminish, a physiotherapist can set up an individualized rotator cuff strengthening and stretching exercise program for you to perform at home or in the gym. This will be based on your needs and abilities, and will help you return to performing your normal routines.
Individuals will often lift weights on their own, to try and build up their shoulder strength. However, in doing so, they can do more damage to their shoulder. It is extremely important to strengthen your muscles properly, as they may have weakened during the period of non-use. A trained therapist will help to ensure your rehabilitation process is effective. For fast and effective results, use BFST® in conjunction with physical therapy and an exercise program.
NSAIDs (Non-steroidal anti-inflammatory drugs) can be used if required to help manage your pain and inflammation. However, these aren't recommended for long term use, as they can cause gastrointestinal difficulties. Some health professionals have also recommended natural supplements such as glucosamine, MSM or hyaluronic acid to help strengthen the injured tissue.
The use of a Shoulder Freezie Wrap® can greatly reduce, if not eliminate, the need for NSAIDs. Cold compression therapy is a natural, less harmful way to reduce your pain and inflammation.
Once the initial swelling has decreased, you can provide pain relief and improve your arm function by using an Inferno Wrap® to increase the blood flow to the area. Gentle massage around the injured area or small shoulder movements (if not painful) will also help increase blood flow, oxygen and nutrients and will prevent stiffness. To increase your comfort and prevent further damage, you may want to stabilize your arm by using a shoulder sling or brace to avoid unpredictable movements.
Please be aware that this information is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider before starting any new treatment or with any questions you may have regarding a medical condition.