Your shoulder has 4 main muscles (supraspinatus, infraspinatus, subscapularis, teres minor) to help stablilize and provide shoulder mobility. Chronic movement (particularly overhead movement) and injuries can cause these muscle tendons to be inflamed. Inflammation will cause you to feel pain and restrict your range of motion. Inflammation is the body's natural response to warn you to rest and pay attention to the painful area. Ignoring it will potentially cause further damage like rotator cuff tears. It's prudent to heed the warning signs and seek out advice to curtail the damage.
Do I need special tests?
Talking to your healthcare provider will be a good start. Your physician can perform noninvasive tests to determine whether the injury is acute/chronic, traumatic/atraumatic, high/low velocity, or any aggravating/relieving movements. Additional imaging tests may be necessary. Many physicians consider ultrasound to be the gold standard for the initial evaluation of rotator cuff disease. CT scans are the most effective in visualizing bony pathology, especially fractures. MRI provides essential visualization of soft tissues, ligaments and cartilage. These tests will help guide the physician on your treatment plan.
What can I do right now?
Initial management generally consists of an evaluation and imaging as stated above. Modification of activity, ice, rest, a short course of NSAIDs, and physical therapy may be utilized initially if deemed a tendonitis, arthritis, or minor tearing of the tendon. If you don't improve within 4-6 weeks or symptoms have worsen in the last few weeks, please contact your physician. There may be microtears (partial to full-thickness) that require intervention. Young active patients with full-thickness tear should be treated operatively, because these tears generally don't heal well and increase in size over time. Fatty infiltration and remodeling can decrease your chance for successful surgical procedure. Furthermore, delaying full-thickness subscapularis tears repair usually lead to premature shoulder osteoarthritis! Talking to your provider will help educate and provide you with the right recommendation.
If you have had any of the signs and symptoms above, please call and schedule an appointment with us. These warning signs could indicate additional pathology that could lead to more damage than you think. Let us help you rehabiliate safely and quickly!
Dr. David Carfagno is a Board Certified Internist and Sports Physician, who trained at the Cleveland Clinic Foundation.
Tri-Quoc Pham M.A. is ACSM Certified Personal Trainer and a 4th year medical student at Arizona College of Osteopathic Medicine
Mehta S, Gimbel JA, Soslowsky LJ. Etiologic and pathogenetic factors for rotator cuff tendinopathy. Clin Sports Med 2003; 22:791.
Rees JD, Wilson AM, Wolman RL. Current concepts in the management of tendon disorders. Rheumatology (Oxford) 2006; 45:508.