The shoulder is a very complicated joint in the body that has a wide range of motion. When something goes wrong with the shoulder, it will hamper the ability to move freely and can continue to cause pain and discomfort when not treated well.
Athletes who participate in activities such as swimming, tennis or any throwing sports can experience this type of repetitive trauma to the shoulder, and as a result are prone to shoulder problems.
An overhead athletic activity is considered to be the movements that require repetitive motions with the arm in at least 90 degrees of forward flexion or abduction or a combination of the two. These patients will usually demonstrate a degree of hypermobility of the shoulder joint resulting from an increased anterior laxity of their shoulder capsule as well as compensatory tightening of the posterior capsule. When a person experience a “looseness” of the shoulder joint, he or she can still have the freedom to function symptom free by the proper work of the dynamic stabilizers crossing the shoulder joint. However, when the rotator cuff muscles are compromised, pain and discomfort will arise in the affected shoulder joint.
The rotator cuff muscles namely the Infraspinatus, Teres Minor, Supraspinatus and Subscapularis are continually being challenged to keep the humeral head centered in the glenoid fossa and prevent any abnormal displacement due to the extreme forces acting on the shoulder. Because of this highly demanding motions in the shoulder joint, the joint capsule and rotator cuff can develop a secondary inflammatory response. Prolonged rotator cuff tendinitis can result in decreased muscular efficiency with loss of dynamic stability that can result to functional instability and tissue failure. Posterior capsular tightness, which manifest as a loss of internal rotation, is often present in overhead throwers that can lead to anterior-superior humeral head translation further contributing to rotator cuff irritation.
Common rotator cuff tendinitis symptoms include:
- avoiding certain activities because they cause pain
- difficulty achieving full range of shoulder motion
- difficulty sleeping on the affected shoulder
- pain or tenderness when reaching overhead
- pain in the shoulder, especially at night
- progressive weakness of the shoulder
- trouble reaching behind the back
Rotator cuff tendinitis which is a condition where the tendons are inflamed can lead to secondary type of impingement and can also make a primary impingement syndrome more symptomatic. Treatment will depend on the cause and severity of the shoulder pain. Rehabilitation focuses on resolving the inflammation by using over-the-counter non-steroidal anti-inflammatory drugs to help reduce pain, icing the shoulder for 15-20 minutes, 3-4x/day and resting the shoulder for several days before returning to normal activity and avoiding movements that might cause pain. Recovery of motion by doing gentle and prolonged stretching techniques and application of specific exercise regimen that will strengthen rotator cuff muscles and scapular stabilizers.
Reference: Clinical Orthopaedic Rehabilitation
- Brent Brotzman, MD and Robert C. Manske, DPT, MEd, MPT, SCS, ATC, CSCS
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