Rotator Cuff Injury: Glossary of shoulder pain

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Glossary of Shoulder Pain

Acromioclavicular joint   The acromioclavicular joint is an articulation between the acromion (part of the shoulder blade) and clavicle. Between this  there are a number of ligaments such  as the coracoclavicular, coracoacromial ligament and conoid ligament.

Acromioclavicular (AC) dislocation  The clavicle (collarbone) is forced out of position.  Usually resulting  from a fall on an outstretched hand.

Calcific tendinitis  This is where the tendon of the rotator cuff becomes calcified due to a prolonged period of abrasion.

Frozen shoulder - also known as adhesive capsulitis.  Frozen  shoulder is where the joint capsule of the shoulder usually hardens in response to trauma or surgery. The result is a generalized stiffening of the shoulder.Capsule  Another term you may hear related to the anatomy of the shoulder joint  is the capsule. A capsule is a membrane or sac in the body, that surrounds a joint  such as the shoulder. The joint capsule of the shoulder goes around the entire shoulder.

The shoulder is a very complex assembly  with a wide range of movement produced by many different bones, muscles and tendons acting together. Unfortunately this flexibility also makes it more unstable and therefore susceptible to injury. Some of these are detailed below.

Tear of the labrum  Here the  edge of the shoulder joint is torn during trauma. Most common in contact sports such as rugby.

Magnetic resonance imaging or MRI   MRI stands for Magnetic Resonance Imaging and is a common procedure for medical diagnosis today. MRI is especially useful to show the soft tissues of the body and can therefore be of great help in the diagnosis of your shoulder pain or  rotator cuff injury. MRI uses a magnetic field to reveal neurological problems, musculoskeletal, cardiovascular and oncological issues.

The rotator cuff   The rotator cuff is another important part of your shoulder and one  often heard associated with shoulder pain. It consists of a number of tendons and  related muscles . The rotator cuff helps stabilize the shoulder, but can also be easily damaged due to a tear or an impingement of the shoulder to give a rotator cuff injury.

Tear of the rotator cuff   This is where  one of the muscles of the rotator cuff tears. You can have a full thickness  tear or a partial  thickness tear. Arthritis of the shoulder   Arthritis of the shoulder is caused by wear and tear changes in the acromion of the shoulder, giving rise to shoulder impingement syndrome.

Shoulder Bursa   A bursa  is a fluid-filled sac located between bones and tendons or muscles around  joints such  as the shoulder. These enable smooth movement  but can become inflamed. If this happens  your doctor will tell you that you have bursitis.

Dislocated shoulder   Shoulder dislocation occurs when the arm bone (humerus) is forced out of the shoulder joint, usually through trauma.


Shoulder Impingement   This occurs when the tendons of the rotator cuff are  pinched in the subacromial space. (This is the space below the acromion part of the scapula).

Shoulder Muscles   Another important part of the anatomy of the shoulder is the shoulder muscles. These muscles connect to the three bones of the shoulder and are responsible for different functions. Some of these muscles include the serratus subclavius, pectoralis minor, sternocleidomastoid, levator scapulae, trapezius and deltoid.

Shoulder X-Ray   If you land heavily on your shoulder then you may have fractured one of the bones that make up the shoulder joint.  X-rays can help to determine this.  X-rays do not show soft tissue like muscles and tendons but they can be used to eliminate the possibility of a fracture. Other forms of radiography such as X-ray contrast dyes or ultrasound may also help to show up more information.

Supraspinatus tendinitis  This is tendinitis of the supraspinatus muscle, one of the muscles of the rotator cuff .  Most often caused by abrasion under the  Acromioclavicular  joint.

Whiplash and Whiplash Associated Disorder   Whiplash Associated Disorder (WAD).  Whiplash is a medical condition that occurs when due to a sudden  force, the head moves forward and then backward, very quickly. Due to the  sudden  slamming of the head,  neck and shoulder  injuries  are common in patients with whiplash.  Whiplash injuries occur frequently in car accidents.

Rotator Cuff Injury: Understanding The Anatomy of your Shoulder

Understanding the Anatomy of Your Shoulder  In order to help you understand some of the medical terms your doctor or physiotherapist may use when discussing your shoulder and rotator cuff injury, here are some common terms and definitions.

The Bones that make up the Shoulder  The shoulder is made up of a number of different bones, muscles and tendons. The three main bones in the shoulder are the scapula, clavicle (also known as the collar bone) and the humerus (the upper arm bone). Between the bones there are joints.

The Acromioclavicular Joint  The acromioclavicular joint is between the acromion (a part of the scapula) and the clavicle. Between this joint there are a various ligaments such as the coracoclavicular, coracoacromial ligament and conoid.

Shoulder Muscles   The shoulder muscles connect to the three bones in the shoulder and are responsible for various functions. Some of these muscles include the serratus anterior, subclavius, pectoralis minor, sternocleidomastoid, levator scapulae, trapezius and deltoid.

Shoulder Bursa  A bursa is a fluid-filled sac that lies between bones and tendons or muscles around joints such as the shoulder. The bursa allows smooth movement but can become inflamed.  If this happens then you have bursitis.

Rotator Cuff  The rotator cuff is a very important part of your shoulder and when things go wrong, either through the wear and tear of aging or because of trauma, then this can cause shoulder pain. The rotator cuff consists of a number of tendons as well as some related muscles. The rotator cuff helps to stabilize the shoulder joint but can also be easily damaged such as a tear or shoulder impingement.

Impingement Shoulder impingement occurs when the tendons of the rotator cuff are pinched in the subacromial space (the space below the acromion part of the scapula).

Joint Capsule  A joint capsule is any membrane or sac  that surrounds a joint.  The shoulder joint capsule goes around the whole of the shoulder. 

Conclusion 

 The shoulder is a complex part of the body with a great range of movement produced by different bones, muscles and tendons all acting together. However, this flexibility also makes it unstable and therefore more susceptible to damage. If you do damage your shoulder or rotator cuff these are some of the terms you will need to know in order to speed your recovery.

For the symptoms of rotator cuff injury go to the SYMPTOMS PAGE.

Physical Therapists Solution to a Rotator Cuff Tear that may help you Avoid Surgery

Summary:
How Mary Hanna reduced her Rotator Cuff Pain using a Training Guide by Physical Therapist Brian Schiff. This guide could also very helpful in strengthening the shoulder and alleviating pain from a variety of shoulder conditions.


After a thorough physical examination, including x-rays, my Doctor diagnosed my arm and shoulder pain as a rotator cuff tear and naturally suggested immediate surgery.  “The Ultimate Rotator Cuff Training Guide” by Physical Therapist Brian Schiff has so far saved me from having to go through that surgery.

After I heard the Doctor’s diagnosis and suggestion, I searched the library and the internet for non-surgical solutions. I may have found a possible answer. I started using Brian Schiff’s Training Guide and followed his very explicit directions for the stretching, range of motion moves and exercises.  I am in week 2 of a 4-6 week regime and have noticed a marked improvement.

In this article I am attempting to explain how this Training Guide has worked for me and would suggest that you to try this method before considering surgery.

Brian Schiff graduated from The Ohio State University in 1996 with a Bachelor of Science degree of Physical Therapy in Allied Health Professions. Since then, he has practiced as a licensed physical therapist specializing in sports medicine.  Through the National Strength and Conditioning Association, Brian became a certified strength and conditioning specialist (CSCS) in 1998.

By doing the exercises in “The Ultimate Rotator Cuff Training Guide”, I came to understand that it was a highly efficient system for relieving pain in the shoulder.  Brian Schiff put together the guide for people with frozen shoulder, osteoarthritis, Rotator Cuff tendonitis, Rotator Cuff tears, impingement or bursitis.
Don’t be intimidated by the fancy words, Brian explains what they all mean and how to use the exercises to alleviate pain. He goes into a detailed description of each particular problem and how to best use the different exercises to your greatest advantage.

There is one disadvantage. It is recommended that the stretching and range of motion moves be done everyday.  To some this may seem daunting, but it is definitely worth it to work this into your daily schedule.  This is not a magic pill; it will take at least 4-6 weeks to start feeling the relief from your regular routine.
In the Ultimate Rotator Guide one of its most valued points is that Brain doesn’t just write out how to do each motion, he has pictures of him actually performing each move.  This is extremely helpful in showing you the right form for each exercise. The right form is essential in making the motions work for you.  So, not only does he outline how to do the moves in the eBook, he has added pictures in all aspects of each move. In the very beginning of the eBook he answers frequently asked questions that he knows from experience.

Another invaluable part of getting his eBook is that if you have any other questions you can email him.  I did, and he always got back to me on the same day.
The Ultimate Rotator Guide is a truly concise map to overcoming shoulder pain.  The eBook logically and easily pulls you through the process of using these exercises to eliminate pain in an attempt to avoid shoulder surgery.
Do not think this will instantly heal you, it will take practice.  You must do the exercises on a consistent basis.  It is critical that you follow the directions to achieve your goal of a pain free shoulder.

When I first started the program I thought that it was impossible to take this much time everyday.  However, after the first week when I had practiced the moves it didn’t take nearly as much time as in the beginning.  I was able to smoothly do all the moves in less than thirty minutes.

Normally there are always some weaknesses in eBooks but I couldn’t find any in the Ultimate Rotator Guide.  My experience is that it is taking away most of my Rotator Cuff pain and is keeping me away from Rotator Cuff surgery.  Remember, I am in week two and much has been accomplished.
Wouldn’t you use a program that would take away most, if not all of your shoulder pain?  If you want to learn how to strengthen your shoulder and relieve your aching I would highly recommend “The Ultimate Rotator Training Guide”.  In fact, I give it 9 out of 10.   I can’t thank Brian enough for supplying this valuable information and hopefully saving me from surgery.

Copyright © 2006 Mary Hanna All Rights Reserved.

This article may be distributed freely on your website and in your ezines, as long as this entire article, copyright notice, links and the resource box are unchanged.

Rotator Cuff Injury Diagnosis

If you have hadshoulder pain for more than a few days that does not seem to be going away then you do need to seek medical advice. These are some of the steps your medical practitioner may go through.

History
Your doctor will need to take a thorough history of the acute injury as well as any previous symptoms that may suggest a more long-term problem.

Physical examination
The physical examination often involves observation to look for any deformities, muscle wasting, and changes in the appearance of the damaged shoulder compared to the normal one.
Palpation means touching, including feeling the bones that make up the shoulder joint. The muscles of the shoulder may be palpated, trying to find areas of tenderness or pain.
Evaluation may include the assessment of range of motion for both shoulders. The power of the shoulder muscles will also be assessed depending upon whether the patient can move the shoulder against resistance or perhaps just lift the arm up against gravity.
Sensation and blood flow in the arm and hand may be assessed.
The care provider may ask about chest pains or breathing difficulties to make certain that the shoulder pain is not referred from the heart.

X-Rays. These are used to look for arthritis within the shoulder joint. Sometimes, calcification can be seen along the tendon.

Advanced imaging studies Magnetic Resonance Imaging: This test is able to identify all the structures that make up the rotator cuff and can identify degeneration changes to partial or complete tears of the injured or damaged tissue.

Ultrasound: This is a sound wave test that can help evaluate damaged tendons and muscles. The benefit of ultrasound is that it can be done as the shoulder is moved and can find places where the rotator cuff is being pinched or impinged upon.




How is rotator cuff tendonitis diagnosed?

Your doctor is usually able to make the diagnosis just by talking to you and examining your shoulder. He or she will ask when your shoulder problems started, whether you have had any specific injury and what aggravates your shoulder problem.They may then perform an examination of your shoulder. This usually involves moving your shoulder in various positions. One of the tests that can help to diagnose rotator cuff tendonitis is called the 'painful arc test'. Your doctor may ask you to start with your arm by your side and then lift your arm outwards from your side in an arc. In rotator cuff tendonitis, pain is usually felt at a maximum between 70 and 120° in this arc.
Occasionally, your doctor may suggest an X-ray of your shoulder or they may refer you for more detailed investigations such as an ultrasound scan or an MRI scan.


Rotator cuff impingement syndrome

Again, your doctor will usually diagnose rotator cuff impingement syndrome just by talking to you and examining your shoulder. You will experience the same painful arc as described above when your shoulder is moved.
Additionally your doctor may also perform a test where they examine your shoulder using the the Neer Impingement Test. In this test they ask you to straighten your arm. They then raise your arm forward, keeping your palm pointing away from your body. If this test is painful, the test is positive and rotator cuff impingement syndrome is likely.
If rotator cuff impingement syndrome is not recognised and treated promptly, it can lead to excessive wear and tear of the rotator cuff tendon. This in turn can lead to weakening of the tendon and the tendon can break, or rupture, causing a rotator cuff tear.


Rotator cuff tears

Again the diagnosis will be taken orally and then via physical examination of the shoulder.
One of the tests that can help to diagnose a rotator cuff tear is called the 'drop arm test'. Your doctor will ask you to stand with your arm by your side. They will lift your arm outwards from your side and up towards your head. They will then ask you to move your arm back down slowly towards your side. In a rotator cuff tear, you are usually able to lower your arm slowly to 90° but when you try to lower your arm below 90°, it drops quickly to your side.

Rotator Cuff Injury: Causes and Symptoms

Rotator Cuff Injury: An Overview

Most shoulder injuries involving pain and discomfort are due to inflammation or irritation of the rotator cuff muscles. This is especially true if only one  shoulder joint is affected and this is on the dominant side.

The rotator cuff muscles work as a unit  to help stabilise the shoulder joint and also to  help with shoulder joint movement. The four tendons of the rotator cuff muscles join together to form one larger tendon: called the rotator cuff tendon. This tendon attaches to the head of the humerus-the bony surface at the top of the upper arm bone. There is a space underneath the acromion of the scapula, called the subacromial space. The rotator cuff tendon passes through there.

What types of rotator cuff injury are there?

There are  different problems that can affect the rotator cuff and lead to rotator cuff injury or inflammation. The most common problems include:

• 1.Rotator cuff tendonitis;
• 2.Rotator cuff impingement syndrome;
• 3.Rotator cuff tears.

1.Rotator cuff tendonitis

Rotator cuff tendonitis is the most common cause of shoulder pain in adults.

What causes rotator cuff tendonitis?

Rotator cuff tendonitis is caused by  inflammation and irritation of the tendons of the rotator cuff muscles. It tends to have an acute  or sudden onset. There will  often be  a specific preceding injury. It can also happen because of  overuse of the shoulder. Often  it can occur in athletes, particularly those who participate in  sports using a throwing motion such as tennis or baseball.. In non-athletes, there may be a recent history of  heavy lifting or activities involving repetitive movements of the shoulder, especially above shoulder level.

Sometimes the rotator cuff tendons can become 'calcified'. This is when calcium is deposited in the tendons due to long-standing inflammation. This is called calcific tendonitis.

What are the symptoms of rotator cuff tendonitis?

The main symptoms are an acute or sudden onset of pain and painful movement of the shoulder. Pain is worst when you use your arm for activities above your shoulder level. This means that the pain can affect your ability to lift your arm up.  Pain may also disturb sleep if lying on the affected shoulder.

2.Rotator cuff impingement syndrome

What causes rotator cuff impingement syndrome?

 The rotator cuff tendon passes in the subacromial space-the space underneath the acromion part of the scapula, or shoulder blade. In impingement syndrome, the rotator cuff tendon gets 'trapped' in the subacromial space. The tendon is then  repeatedly 'scraped' against the shoulder blade which can eventually lead to fraying of the tendon. Over time the tendon weakens and is more likely to tear.

Impingement syndrome can occur because of long-standing 'wear and tear'. This means it tends to be seen more in the middle-aged. It can also happen due to problems with the bone of the acromion. These can include arthritis and bony spurs  called protrusions.

What are the symptoms of rotator cuff impingement syndrome

Rotator cuff impingement syndrome also causes shoulder pain. However, the pain tends to be more chronic (long-standing). The pain tends to be worse during activities when your arm is raised over your head. Pain can also be worse at night time especially if sleeping on the affected shoulder.

3.Rotator cuff tears

Who gets rotator cuff tears?

Rotator cuff tears are most common in middle-life, i.e. those over 40.

What causes a rotator cuff tear?

Rotator cuff tears are usually tears in the rotator cuff tendon rather than in the muscles themselves.

 In younger people, a rotator cuff tear normally happens as a result of  injury due to a fall or accident.

 In older people tears are often caused by rotator cuff impingement syndrome (see above). Here, the repeated damage to the 'trapped' tendon means that the tendon frays, weakens and is then  more likely to tear.

Depending on the degree of damage to the tendon,  rotator cuff tears can be classified as  minor (partial) or full (complete).

What are the symptoms of a rotator cuff tear?

As usual pain is the most common symptom of a rotator cuff tear. If it is a tear the pain will usually be much worse than that due to tendonitis or impingement. The pain tends to be over the front and outer part of the shoulder.  Your shoulder or arm can also feel very weak and you may have reduced movement in your shoulder. This is caused by the muscles going into spasm as they seek to protect the shoulder. The pain will usually be worse if your arm is moved above and then behind the head-for example when combing the hair. Some people feel clicking or catching when they move their shoulder.