Understanding your shoulder: bursitis and rotator cuff tears
Have you been told you have shoulder bursitis?
What about a rotator cuff tear?
You're not alone. These are some of the most common shoulder problems that people come into the physiotherapy clinic with. One of the most important steps of getting on top of the pain is first understanding what's really going on with your shoulder.
What's causing the pain?
It's not only the bursa that is contributing to your pain (even if your scans say so!). The shoulder girdle is a highly complex structure consisting of four different joints. The main joint that people generally relate to the shoulder girdle is the glenohumeral joint, which is a ball-and-socket connecting your arm to your body. All of the joints and muscles need to work together to perform a simple movement such as lifting your arm up above your head. If one or more of the muscles aren't doing their job properly, the movement gets disrupted and different structures in the shoulder can become compressed. Common structures include:
Rotator cuff tendon
Compression of joint structures can lead to pain and clicking/clunking in the shoulder.
What is the rotator cuff?
The rotator cuff is a group of four muscles that sit within your shoulder blade and attach to the top of your upper arm bone (humerus) - forming a cuff around your shoulder joint. These muscles help rotate your shoulder inwards and outwards, and keeps the ball of your humerus stabilised in its socket.
The stabiliser role of the rotator cuff is extremely important during all shoulder movements such as reaching into the cupboard or lifting a grocery bag. If the rotator cuff muscles aren't functioning as they should, it can lead to pain during these movements.
I have a rotator cuff tear on my scans!
The good news about the rotator cuff is that all four of the muscles blend together at the humerus and help each other out when it comes to shoulder movement. This means that even if one muscle is injured or torn, the shoulder can still function normally. It often helps to picture the rotator cuff like a blanket that's wrapping around the shoulder. If we cut a hole in a blanket, it will still serve its function of keeping us warm. A Physiotherapist can discuss your scan findings with you at your consultation.
Lots of people over the age of 30 are currently walking around with tears in their rotator cuff and in no pain at all. Likewise, your scan might show up clear but your shoulder pain is telling you a different story. Everyone's pain is different, which is why a full assessment needs to be completed before coming up with a treatment plan that will work best for you.
Of course, if you've experienced a traumatic injury to your shoulder, are experiencing unremitting pain or are feeling generally unwell - please consult with your physiotherapist or a trusted health professional.
Breaking the cycle of inactivity
The most common mistake that people make when it comes to shoulder pain is avoiding using it altogether. This often seems like the only option when the shoulder gets so sore that it becomes difficult to do something as simple as getting dressed, let alone lifting weights at the gym. Avoiding use of the shoulder leads to muscle weakness, which then makes it harder for the muscles to do its job. This means that the joint has less support and more stress is put on the already painful shoulder structures. And so the cycle repeats.
The first step to breaking this cycle is knowing where to begin (and when to stop). Often it takes something as simple as getting a few muscles working and making some small lifestyle adjustments to settle down the pain. It is important to monitor your symptoms when starting a new exercise to ensure recovery is on the right track. Physiotherapists can help you along this journey by providing pain management strategies and specific exercises suited to your pain and lifestyle.