Something about the Shoulder Joint
The shoulder (glenohumeral) joint is a ball and socket joint and comprises a large spherical (humeral)
head and a small glenoid cavity. This anatomy of the shoulder joint makes it highly mobile but at the
expense of stability. Therefore, the shoulder joint is susceptible to injuries such as tendon or muscle
tear, dislocation and fracture (broken bone).
Rotator Cuff Muscle - the Big 4 muscles of the shoulder joint
The rotator cuff muscle comprises of 4 muscles, namely, Supraspinatus, Infraspinatus, Teres Minor,
Subscapularis, which attach to the shoulder like a cuff, and their functions are mainly for turning
(rotating) the upper arm inwards or outwards, hence the name “Rotator Cuff”. Biomechanically, the
rotator cuff muscles stabilise the shoulder joint by compressing the humeral head against the glenoid
cavity. These 4 muscles arise from the shoulder blade (scapula)and insert into the humerus. The
tendons of the rotator cuff muscles blend with the joint capsule and form a musculo-tendinous collar
which surrounds the back , upper and front aspects of the joint, leaving the lower aspect unprotected.
Rotator Cuff Injury and Tear
Common causes of the rotator cuff tear or injury is from playing sports, repetitive strain or traumatic
injury such as road traffic accident and falls.
3 Common symptoms of Shoulder injury/ Rotator Cuff Injuries or Tear are:
1. Pain
Pain is a common symptom which can be at rest or only during shoulder movements. Sometimes
sleeping on the affected side can be painful. In some cases, even sleeping on the non-affected side
can cause pain in the affected side.
2. Stiffness
People experience a lack of range of movement in the shoulder joint, the stiffness can be related to
pain and or weakness of rotator cuff muscles or muscles around the shoulder joint complex. Normal
functional daily activities such as putting on or taking off clothes, washing or combing hair, reaching
for cupboard above head, can be difficult to perform.
3. Weakness
Weakness of the shoulder joint can be related to pain, functional or disuse weakness of the rotator
cuff muscles following the injury. Sometimes the shoulder joint muscles become “weak” due to poor
movement pattern or adaptive protective postures. The rotator cuff muscles work like a symphony
orchestra: they have to work in synchrony and harmony. The rotator cuff muscles work to stabilise
the shoulder blade (scapula) in order to allow the shoulder joint to move smoothly and with minimal
effort. If this mechanism is compromised, the shoulder movement can be painful and difficult.
Conservative Treatment for Shoulder Pain/ Rotator Cuff Injuries
Physiotherapy is the major nonsurgical treatment of shoulder pain and rotator cuff injuries. Accurate
physical and functional diagnosis is essential and is carried out by an experienced physiotherapist
who would identify the cause of the symptoms and other comorbid factors which perpetuate or
reinforce the symptoms. Other psychological barriers such as fear avoidance and catatrophisation
are identified and managed to allow maximal treatment outcomes following shoulder injuries.
Physiotherapy interventions include but not limited to:
Dry needling - with the aim to reduce pain, increase mobility and promote recovery
Manual therapy - to facilitate movement so that the shoulder joint movements are repeated with
minimal or no pain and to reinforce a more normal movement pattern to restore optimal functional
mobility.
Shockwave therapy - can reduce pain, inflammation, increase mobility and assist with rotator cuff
tendon repair and recovery.
Home Exercise Program - it is important to maintain the range of movement gained after the
treatment, regain confidence with shoulder movements, and to prevent further complications such as
development into chronic pain and stiffness of the shoulder joint.
Postural awareness and correction - it is important to maintain an optimal posture in order to
prevent aggravation of shoulder symptoms.
Surgical treatment
Fractures in the Shoulder Joint
Most fractures can be healed with immobilisation in a sling for about 4 to 6 weeks. X-rays will be used
to determine whether the fracture has healed sufficiently to permit motion exercises. During the
immobilisation period, it is important to maintain flexibility of your elbow, wrist and fingers with
instructions from your physiotherapist.
In some cases, surgery may be required to stabilise the displaced fracture fragments to preserve
better congruence of bone and maximise mobility and function after the fracture site is healed.
Rotator Cuff Tear/ Injury
According to American Academy of Orthopaedic Surgeons (AAOS), in around 80% of people,
nonsurgical treatment may be effective in resolving rotator cuff issues, such as lack of movement, and
pain.
There is some evidence to suggest that surgery may not be more effective than conservative
treatment, and therefore nonsurgical treatment is often initially recommended.
Surgical treatment may be considered if nonsurgical treatment options have not been successful: The
surgery aims to manage shoulder pain, weakness or both.
In the case of larger tears, surgical intervention may be the better option.
However, there are some limitations to rotator cuff surgery.
Summary
It is critical to correctly identify the cause of shoulder pain in order to reduce pain, weakness and
improve mobility. Physiotherapy plays an important role in managing pain and symptoms associated
with shoulder injury or rotator cuff tears in a nonsurgical way.
Talk to your physiotherapist next time if you have shoulder injury or pain associated with rotator cuff
injuries.
