One common diagnosis physiotherapists treat is rotator cuff injury. It is quite different from frozen shoulder, which can be a chronic result of rotator cuff problem.
The rotator cuff is a group of tendons and muscles in the shoulder, connecting the upper arm (humerus) to the shoulder blade (scapula). The rotator cuff tendons provide stability to the shoulder and allow it to rotate. The main function of the rotator cuff is to stabilize and provide support to the humeral head in the joint socket, the glenoid cavity.
The muscles in the rotator cuff include:
Teres minor (rotates arm out)
Infraspinatus (rotates arm out)
Supraspinatus (lift arm above 60 degrees)
Subscapularis (rotates arm in)
Each muscle of the rotator cuff inserts at the scapula, and has a tendon that attaches to the humerus which passes through a narrow canal called acromial bursa. Together, the tendons and other tissues form a cuff around the humerus.
Broadly classified, there are two types of rotator cuff injuries, traumatic – where one of the tendons tear completely or partially and the other, degenerative – where thickening of the tendons cause a pinching sensation in the shoulder when the arm is elevated above 60 degrees.
To site an example, a 65-year-old male patient Alex (not real name) could not do any over-head activities without feeling a sharp stab in his right shoulder, which he considered as neck pain. Upon examination, his job entailed stacking shelves at the supermarket, which meant repeated carrying of load over 90 degrees of shoulder elevation. His work taxed the supraspinatus tendon and other tendons due to the kind of rotation involved.
As physiotherapists, we carry out several "special tests" which help us with the diagnosis. In this case, I performed empty can test, which entails making a fist with thumb pointing downward and raising the arm up from the side. Sharp pain is an indication the is test positive, as was the case with Alex.
So why neck pain? In order to continue doing its job, the neck muscles started compensating for restriction of this movement causing work over load. Those muscles are not designed to carry loads, hence the stiffness and pain.
My treatment of choice in this case:
1. Reduce inflammation
2. Create space in the shoulder joint using mobilization and manual therapy
3. Simulates work activity and taught correct ergonomics for the same
4. Stretch tight neck muscles, and strengthen weak shoulder muscles that Alex was avoiding to use
5. Re-establish co-ordination, alignment and equilibrium of the shoulder complex with targeted exercises. Alex was back at work full capacity after 8 sessions of physiotherapy
Physiotherapy doesn't have to be painful and it is not rocket science if knowledge is applied correctly and accurately.
Rina Pandya-Desai is a physiotherapist working in Rehab Center, located in Shatti Al Qurum in Muscat, Oman. She is a member of American Physical Therapy Association and holds a physiotherapy license issued by the Ministry of Health, Government of Oman. Rina can be contacted on firstname.lastname@example.org