Causes of injury to the rotator cuff can be from external or internal factors. External factors can include poor mechanics, or even pain and/or fatigue leading to altered mechanics. Internal factors include age, genetics, blood supply or altered load (1). Excessive load can occur from one instance involving a trauma or repetitive motion leading to the tendinopathy. The mechanism of injury can also be due to a combination of both external and internal factors. The symptoms of rotator cuff tendinopathy typically include pain, reduced range of motion and weakness (1).
One of the most common questions after a rotator cuff injury is if imaging is necessary. An x-ray of the bony structures or an ultrasound of the soft tissue structures may be warranted. However, research has shown that it is very common that irregularities can be found on imaging, even in asymptomatic individuals. This means that imaging may not be the gold standard for diagnosing rotator cuff injuries (2).
A physiotherapist can assess an individual's movement patterns to determine the possible source of the rotator cuff tendinopathy. This includes a functional assessment of the various parts of the shoulder, as well as the neck and mid back. By assessing the areas surrounding the shoulder, the physiotherapist can determine if a structure other than the shoulder is responsible for the injury. These other areas could lead to poor mechanics and overuse of the rotator cuff.
A treatment plan is then developed which will likely include manual therapy and a home exercise plan. It is important to avoid aggravating movements and pushing into pain with rotator cuff tendinopathy without proper direction. To learn more about pain, see Know Pain, Know Gain. Not No Pain, No Gain.
Other options for treatment may include medications or corticosteroid injections. If conservative treatment strategies are not successful, surgical consultation may be a consideration.