Shoulder Pain & Rotator Cuff Syndrome

Shoulder pain is a common condition that can affect people in all walks of life and during anytime in their lifetime. It is very common in seniors and is of course due to the aging process that affects the joints, making them more susceptible to the stresses and weight bearing that is constantly being placed on the shoulder joints. This is compounded by the highly mobile, and complex movements that are involved in the upper limbs.

Your rotator cuff is made up of the muscles and tendons in your shoulder. Four major muscles (subscapularis, supraspinatus, infraspinatus and teres minor) and their tendons connect your upper arm bone (humerus) with your shoulder blade. They also help hold the ball of your upper arm bone firmly in your shoulder socket, as if holding a golf ball on a tee. The combination results in the greatest range of motion of any joint in your body.

Rotator cuff injuries are fairly common. Causes of the injury may include falling, lifting and repetitive arm activities, especially those done overhead. These activities may include throwing a baseball, reaching up to work on a car on a rack or placing items on shelves above your head. The injury is also common among people whose jobs or hobbies include heavy demands on their shoulders, such as athletes, archers and people in the construction trades. Poor posture, especially as related to your shoulders hunched forward, also can contribute to rotator cuff injury. As you get older, your risk of a rotator cuff injury increases.

The most common symptom is pain. You may experience it when you reach up to comb your hair, bend your arm back to put on a jacket or carry something heavy. Lying or sleeping on the affected shoulder also can be painful. If you have a severe injury, such as a large tear, you may experience continuous pain and muscle weakness. You may also have the following:

  • Pain and tenderness in your shoulder, especially when reaching overhead, reaching behind your back, lifting, pulling or sleeping on the affected side
  • Shoulder weakness
  • Loss of shoulder range of motion
  • Inclination to keep your shoulder inactive

Shoulder pain involves any type of irritation or damage to your rotator cuff muscles or tendons, including:

  • Tendinitis. Tendons in your rotator cuff can become inflamed due to overuse or overload, especially in athletes who perform a lot of overhead activities, such as tennis or racquetball players. In some people, the space where the rotator cuff resides can be narrowed due to the shape of different shoulder bones, including the outside end of the collarbone or shoulder blade.

  • Bursitis. The fluid-filled sac (bursa) between your shoulder joint and rotator cuff tendons can become irritated and inflamed. The bursa is a little sack of fluid that allows the muscles to glide smoothly as they are flexed or extended. There are two areas where this bursa is located and they can become swollen, inflamed or even infected. In an acute bursitis, the patient generally complains on any movement of the arm, and is generally worse at night, with difficulty in sleeping on the affected side. Pain and tenderness is generally located on the point of the shoulder. An acute bursitis left untreated can develop into a chronic bursitis.

  • Strain or tear. Left untreated, tendinitis can weaken a tendon and lead to chronic tendon degeneration or to a tendon tear. Stress from overuse also can cause a shoulder tendon or muscle to tear.

  • Nerve Impingement. Pains that occur along the top of the shoulder, and radiate into the side of the upper arm into the deltoid muscle, and further down the arm, even into the fingers, may be related to nerve impingement (pinched nerve), which can originate in the neck (cervical spine). Depending on the side of the hand, or the fingers affected will determine the nerve branch involved. This condition called “Brachial Neuritis”, or “Brachial Neuralgia”, is due to the involvement of the group of nerves exiting from the spinal vertebrae, called the “Brachial Plexus”. The pain can be very intense on any movement of the arm and any pressure along the distribution of the nerve pathway.

  • Referred Pain. Pains that occur under the shoulder blade may signal a warning that the pain is not in the shoulder itself, but can be related to a pain from one of the organs in the body. The shoulder where the pain occurs can give the clue which of the organs are affected and causing the radiating pain into the shoulder. Pain under the left shoulder blade can be a signal that there is a problem with the stomach or in the chest. Pain under the right shoulder blade can be a signal of a gall-bladder inflammation or gallstones. Or it can relate to liver disease, or a problem with the duodenum.

  • Muscle Spasms. Pains that occur over the shoulder blade (scapula) area can be due to the large muscle (trapezius) and underlying smaller muscles that have become spastic. The spasticity of the muscles can be brought on by overuse or trauma to the muscle. The muscle will develop a nodule or nodules that will in turn cause trigger points that often send radiating pains to sites far removed from the trigger points.

Common causes of rotator cuff injuries include:

  • Normal wear and tear. Increasingly after age 40, normal wear and tear on your rotator cuff can cause a breakdown of fibrous protein (collagen) in the cuff's tendons and muscles. This makes them more prone to degeneration and injury. With age, you may also develop calcium deposits within the cuff or arthritic bone spurs that can pinch or irritate your rotator cuff.

  • Poor posture. When you slouch your neck and shoulders forward, the space where the rotator cuff muscles reside can become smaller. This can allow a muscle or tendon to become pinched under your shoulder bones, including your collarbone, especially during overhead activities, such as throwing.

  • Falling. Using your arm to break a fall or falling on your arm can bruise or tear a rotator cuff tendon or muscle.

  • Lifting or pulling. Lifting an object that's too heavy, or doing so improperly — especially overhead — can strain or tear your tendons or muscles. Likewise, pulling something, such as an archery bow of too heavy poundage, may cause an injury.

  • Repetitive stress. Repetitive overhead movement of your arms can stress your rotator cuff muscles and tendons, causing inflammation and eventually tearing. This occurs often in athletes, especially baseball pitchers and tennis players. It's also common among people in the building trades, such as painters and carpenters.

Most of the time, treatment for rotator cuff injuries involves exercise therapy. Your doctor or therapist will talk with you about specific exercises designed to help heal your injury, improve the flexibility of your rotator cuff and shoulder muscles and provide balanced shoulder muscle strength. Depending on the severity of your injury, rehabilitation therapy may take from three weeks to several months.