Rotator cuff related shoulder pain diagram

What is Rotator Cuff Related Shoulder Pain?

The shoulder complex has many muscles which help move the shoulder through a wide range of movement. There are 17 muscles that attach to the shoulder blade. There is an arch over the top of the ball and socket joint (glenohumeral joint) consisting of the acromion (end of the shoulder blade) and the collar bone or clavicle.

The space underneath this arch is called the subacromial space. Within this, lie the four rotator cuff tendons which wrap around the head of the arm bone (humerus). The terms rotator cuff related shoulder pain (RCRSP) and Sub-acromial Pain Syndrome (SAPS) are used to describe a problem with the structure(s) within the sub-acromial space.

Causes

Rotator Cuff Related Shoulder Pain (RCRSP) is is a very common problem and causes pain in the shoulder and upper arm but does usually respond to exercise.

  • It can radiate as far as the elbow and occasionally into the lower arm.
  • There is often a dull ache at rest as well as sharp pain associated with certain positions e.g. sudden forward movement of the arm.
  • Some patients with RCRSP may also experience pain in the neck muscles on top of the shoulder.
  • The most common reason for symptoms is often a change (up or down) in your activity levels or how you use your shoulder.

Shoulder pain can be related to, poor general health (including high blood pressure, diabetes and obesity), smoking, reduced fitness poor sleep and stress.

Symptoms

  • Pain felt from RCRSP is normally on the outside of the upper arm. It can radiate as far as the elbow and occasionally  into the lower arm.
  • Often patients with RCRSP will also experience pain in the neck muscles on top of the shoulder.
  • There is often a dull ache at rest as well as sharp pain associated with certain positions e.g. sudden forward movement of the arm.

Treatment

There is increasing evidence that conservative (non-surgical) management is very effective at managing this condition.

Activity modification

  • Initially, it is best to rest from painful activities and modify your activities.
  • It is always important to keep moving, however resting from painful activities in the short term can ease strain on the shoulder allowing it to recover. Once pain has settled, you can gradually return to normal activities.
  • This condition is normally worse when the arm is lifted forward or sideways to shoulder height or reaching behind your back. Modifying these positions will help the shoulder improve. If you need to lift an object, consider bending your elbow first, or reducing the amount you are lifting. Where possible you should avoid lifting objects to shoulder height.

Pain relief

Using a heat or cool pack on a painful shoulder might help to relieve the pain.

Both heat and cool can be helpful but be careful not to put ice, heat packs or hot water bottles directly on your skin. Instead wrap them with a tea towel or cover.

Over the counter painkillers like paracetamol will ease the pain but need to be taken regularly to control the pain.

A short course of anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely.

Follow the instructions on the packet and discuss using them safely with a pharmacist or GP, especially if you have any underlying health conditions.

Exercises

Visit the British Elbow and Shoulder Society website to find exercise to help improve your pain and function. This link will take you to some exercises that will help with improve your pain & function

Posture

It is important to remember that there is no ‘perfect posture’, you should move and change positions often throughout the day.

Spinal and shoulder posture can have a significant effect on how your shoulders move.

Try to focus on achieving a relaxed, comfortable posture and moving or changing position once every 30-45 minutes.

When to seek help?

Following the above advice, symptoms should gradually settle over 6-12 weeks, though full recovery may take several months. If symptoms fail to improve in this time or become more painful, further treatment or investigation may be required.

If your symptoms continue after trying conservative management, you should discuss further treatment options with your healthcare practitioner.

Your healthcare practitioner may refer you to a physiotherapist for a tailored treatment programme.

Alternative treatment options may include local injections and surgical management.

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