older woman receiving shoulder and rotator cuff physiotherapy in Southampton by a physio therapist

Shoulder and Rotator Cuff Physiotherapy in Southampton

Shoulder Diagnostics and Physiotherapy 

We provide shoulder and rotator cuff physiotherapy in Southampton and Eastleigh. Before you start therapy, we recommend you have a shoulder scan (ultrasound) which may shed more light as to the nature of you injury. It is because you may end up spending a lot of money on therapy whereas an additional scanning (i.e. MRI) and diffrent approach was required. Contact us with any further questions if you are interested in physiotherapy and shoulder scan.

Shoulder physiotherapy and impingment 

The shoulder joint is very interesting. It is, first and foremost, very complex and diagnosing its pathology is not always easy. There are so many different structures that can be a source of pain. One diagnosis that patients frequently receive is shoulder impingement syndrome; the diagnosis is somewhat controversial, and it does not explain what is happening within the shoulder. Lewis (2011) even questions the diagnosis and suggests other non-surgical options for treating the problem. Special tests that clinicians use are not always helpful. There are over 200 special tests, and their diagnostic value is rather poor.

Shoulder assessment with musculoskeletal ultrasound

In the clinic, we use an ultrasound scan to help diagnose shoulder injuries. This can also help confirm clinical findings and rule out various pathologies.

 

ultrasound scan diagram of a shoulder rotator cuff injury

shoulder injury – the supraspinatus tendon tear

 

Ultrasound can be especially useful in an assessment of the rotator cuff. Intra-articular (within the joint) injuries are best assessed by MRI, and sometimes we advise to have it done. It all depends on clinical presentation and symptoms.

Causes of shoulder pain

Patients often feel frustrated as nobody seems to know what might be causing pain.  Over the next few months, I will write about different causes of shoulder pain. Visit my blog to find out more about:

  • Torn cartilage/labrum—This injury is not as common as a rotator cuff injury; however, the cartilage tear may result from a fall or shoulder dislocation. It is also more common in overhead athletes (overuse injury), such as cricketers. There are a couple of main cartilage injuries, such as SLAP lesion and Bankart lesion
  • Rotator cuff injury.
  • Swollen bursa—The subdeltoid subacromial bursa is hardly visible on ultrasound scanning, but if you have a full-thickness tear or other injury to the shoulder, it responds by swelling, and we find fluid in it. A swollen bursa may make lifting the arm quite difficult and lead to so-called impingement/bursal bunching. A swollen bursa does not necessarily mean inflammation, which can be checked on an ultrasound power doppler.
  • Bone spurs or osteophytes (bony projections that develop along the edges of bones).
  • A pinched nerve in the neck or shoulder.
  • Broken shoulder or arm bone.
  • Frozen shoulder.
  • Long head of biceps rupture.

Rotator cuff – a common source of pain in the shoulder

The rotator cuff is stabilizing the shoulder joint. Its injuries account for 70% of all cases with shoulder pain. The SST (supraspinatus tendon) is the most prone to injury, with other tendons (subscapularis, infraspinatus, teres minor) being far less likely to be injured.

The common supraspinatus tendon tears may occur close to the articular side, bursal side ( close to the deltoid muscle) or within the tendon.

In terms of size, there are partial-thickness tears, full-thickness tears or complete ruptures.

SST injury may be accompanied by excessive fluid in the bursa, cortical changes and tears in other tendons, mainly the infraspinatus and subscapularis.

Injuries to the rotator cuff cause the deltoid to pull on the arm bone and cause biomechanical changes, and, consequently, this may lead to the acromio-clavicular joint being affected.

Today, though, we will concentrate on one of the most common causes of shoulder pain and stiffness: arthritis.

Shoulder Pain and Rotator Cuff Injuries 

Shoulder pain and rotator cuff injuries are very common. It is said that the rotator cuff problems account for even 70% of all shoulder problems. The rotator cuff is a group of 4 muscles and tendons that stabilise the joint. The supraspinatus, subscapularis, infraspinatus and teres minor provide essential support to the shoulder joint. Injuries, particularly those of the supraspinatus tendon, are very common. The shoulder joint is very shallow ( in contrast to the hip joint), and the rotator cuff provides adequate stability when you use your shoulder and arm. It helps the head of the humerus to sit tight in the socket (in the glenoid, which is part of the shoulder blade). It also helps some shoulder movements like abducting the arm (moving the arm to the side), external and internal rotation.

detailed muscular diagram of shoulder pain and rotator cuff injuries

The shoulder joint is complex, with many structures that may cause pain.

Shoulder Scan 

There are three scans that your doctor or a physiotherapist may recommend for the shoulder. First of all, you may have an x-ray to check bony contours, check for fractures (in case of trauma), and assess the joint space. especially in the context of shoulder joint osteoarthritis. X-ray, however, will not show many other frequent pathologies within the shoulder (for example, soft tissue injury). If there was a trauma ( such as a car accident or fall), you might have an ultrasound scan ( we provide it in our clinic), which is a fast and safe way to visualise the rotator cuff and assess also other structures within the shoulder. In some cases, you may also need an MRI, but this investigation is more expensive, and you require more time to have it done. It provides, however, a lot of useful information about extra- and intraarticular structures.

Diagnosing Rotator Cuff Injury

I have to be entirely honest; It is difficult to diagnose shoulder pain; hence, we use diagnostic ultrasound to assess the rotator cuff and other shoulder structures as part of the physiotherapy initial assessment. Special tests commonly used in diagnosing rotator cuff disease are not very sensitive or specific. Physiotherapists often use a cluster of tests to come to some conclusion, but even then, the diagnosis cannot be made with 100% certainty.  We also have to remember that many patients think the pain comes from the shoulder, whereas the problem is in the upper trapezius muscle or the neck.

man holding his bright red shoulder in pain in need of shoulder and rotator cuff physiotherapy

Rotator cuff pain may affect your quality of life.

Shoulder Pain – Why We Scan the Shoulder?

We use ultrasound scans to visualize all rotator cuff tendons and assess for muscle atrophy. The scan also gives us a chance to assess other structures. We check the acromio-clavicular joint and the posterior (back) of your shoulder joint for signs of effusion in the joint. Ultrasound findings are important in terms of adding diagnostic accuracy and, what is sometimes more important, ruling out other pathologies.  For example, the patient might come to see us with previously diagnosed shoulder impingement syndrome, but the scan reveals advanced calcific deposition disease.

Shoulder Pain and Rotator Cuff Injuries – Tendinopathy

Rotator cuff tendinitis/tendinopathy: this is the most common pathology.  With repetitive overhead activities such as volleyball, tennis, swimming and weightlifting, the rotator cuff may get irritated and degenerative, and overuse and signs occur. The pain may also occur due to too much activity too quickly. For example, returning to sport after a long time of inactivity may cause rotator cuff injury and subacromial bursitis. Tendinitis/tendinopathy occurs when the rotator cuff tendons become swollen and painful. We see rotator cuff pathology even in young athletes and middle-aged people.

Rotator Cuff Pain – Work Related Injury

You may also develop tendinopathy with repetitive movements of the shoulder at work. Cleaners, painters, decorators, and builders are at higher risk of developing tendinopathy. However, it may also occur in more sedentary individuals. Chronic diseases such as diabetes and obesity are also associated with rotator cuff tendinitis/tendinopathy.

Rotator Cuff Tear

Rotator cuff tears are relatively common. The older you get, the higher the risk of degeneration of the tendon and tears. The risk is higher for patients aged 50 and over. Tears do not have to be painful but tend to enlarge in time, and sometimes, the whole tendon may rupture. Some patients with ruptured tendons do not have any recollection of shoulder injury or pain. Tears may be partial or complete. Partial tears usually occur at the tendon’s weak point, which is at its insertion. It is the supraspinatus tendon that is most prone to this type of injury.

Rotator Cuff Tear Symptoms

  • You may have recurrent pain, especially with certain activities.
  • Pain is likely to affect the front and the side of your shoulder
  • It may be difficult to sleep on the injured side.
  • Grating or crackling sounds when moving your arm.
  • You may have limited ability to move your arm.
  • Your shoulder may feel weak, and there may be a loss of power.

Shoulder bursitis

There are a few bursae in the shoulder. The main one is the sub-acromial sub-deltoid bursa (SASD). Thickening or swelling of the bursa is easily detectable on ultrasound.  Bursitis, bursa’s inflammation, is frequently managed conservatively with activity modification, non-steroid anti-inflammatory medications, and corticosteroid injections. Rarely surgical (arthroscopy or open approach) intervention is required (Knipe 2022). Septic bursitis would warrant the use of antibiotics (Aaron et al., 2011).

Biceps tendon pathology and shoulder pain

The biceps tendon ( especially its long head) may cause pain in the anterior part of the shoulder. We often see pathology of the tendon and its sheath. You may develop conditions such as tendinosis, swelling of the tendon, and loss of fibrillar pattern. The other condition is tenosynovitis, with inflammation of the tendon sheath. Sometimes, we can detect fluid in the tendon sheaths, but this is a normal finding as fluid comes from the shoulder joint. A degenerative tendon is weak and may lead to a tear or even rupture. With rupture, a popey’s sign (or deformity) will be visible. The distal biceps tendon pathology explained below is unlikely to give you shoulder pain.

Torn tendon bicep rupture diagram

biceps rupture – a characteristic popey’s sign

Biceps rupture and the Hook Test

Are you concerned you might have ruptured the distal part of the biceps tendon? The Hook test is a simple way of checking if this is the case. Visit Physiopeadia to learn more about the signs of the distal biceps tendon rupture signs and how to carry out the test. Contact us should you need further diagnostics including a scan of the anterior elbow.

Biceps Provocation Test

BPT is a useful test to check for signs of a partial tear or tendinosis of the distal biceps tendon. It consists of two parts and is very sensitive to detect pathology. The patient needs to flex the elbow to 70 degrees and then flex the elbow with resistance in the forearm pronated and supinated. 

Sharp Pain in the Shoulder 

If you have acute shoulder pain due to tendinopathy or a tear, try to avoid certain activities. Especially lifting the painful arm up over the head would not be good. Do not stop moving your shoulder completely, though. Instead, by doing certain exercises (ask your physiotherapist), you should slowly but gradually get more strength in your shoulder, and the pain should also subside over time. Also, consider using non-steroid anti-inflammatory medications such as ibuprofen or naproxen.

Surgery for Shoulder Pain and Rotator Cuff Injuries 

Surgery is not as effective as some may think. Good-quality research projects have shown that an operation/surgery is not superior (better) to physiotherapy in patients with subacromial symptoms and pain. Surgery always carries a risk of side effects and may cause other shoulder problems.

Shoulder Physiotherapy – Arthritis

We often see patients with shoulder pain in need of physiotherapy in our clinic in Southampton. Patients may have pain due to a number of reasons. Arthritis is one of them.

Arthritis is a common condition leading to stiffness, pain, and inflammation.

In the UK, more than 10 million people have arthritis or other, similar conditions that affect the joints. Arthritis affects people of all ages, including children.

Osteoarthritis is the most common type of arthritis in the UK. It affects nearly 9 million people. It most often develops in people in their mid-40s or older. It’s also more common in women and people with a family history of the condition. But it can occur at any age as a result of an injury or be associated with other joint-related conditions, such as gout or rheumatoid arthritis.

Shoulder Physiotherapy – what is Arthritis

Shoulder arthritis is damage to the cartilage inside the shoulder joint. The shoulder consists of two joints. Shoulder arthritis commonly refers to the bigger ball-and-socket joint named the glenohumeral joint after the bones it connects (glenoid and humerus). The cartilage covers both the ball (the humeral head) and the socket (the glenoid).

https://www.hopkinsmedicine.org/health/conditions-and-diseases/shoulder-arthritis#vm_A_a393e1ec

In arthritis, the cartilage in the shoulder begins to break down on the surface and, eventually, in the deeper layers; it’s called shoulder arthritis. The second joint in the shoulder, the acromioclavicular or AC joint, can also develop arthritis known as AC joint arthritis

Shoulder Physiotherapy – signs of Arthritis

Patients with arthritis often complain about stiffness, especially in the morning.  Other symptoms include:

  • Joint pain and tenderness.
  • Inflammation in and around the joints.
  • Restricted movement of the joints.
  • Warm red skin over the affected joint.
  • Weakness and muscle wasting.

Shoulder Physiotherapy – Osteoarthritis (OA)

Osteoarthritis initially affects the smooth cartilage lining of the joint. This makes movement more difficult than usual, leading to pain and stiffness. Once the cartilage lining starts to roughen and thin out, the tendons and ligaments have to work harder.

This can cause swelling and the formation of bony spurs called osteophytes.

Severe loss of cartilage can lead to bone rubbing on bone, altering the shape of the joint, and forcing the bones out of their normal position.

The most commonly affected joints are those in the:

  • Spine
  • Hands
  • Hips
  • Knees

Shoulder Physiotherapy in Southampton

Let us know if you need help with shoulder pain. We will:

  • Carry out a detailed clinical examination
  • Carry out a diagnostic ultrasound scan
  • Provide therapy.
  • Prescribe appropriate exercises for you to do at home.

Physiotherapy and massage can help patients in Southampton start feeling better. We will start, however, with diagnostics and carry out clinical tests and then a scan if required. The key is to strengthen the shoulder, increase the range of motion and improve the overall function of the joint. We will work with you to relax the shoulder joint and improve the overall function of the rotator cuff, stabilizing the shoulder.

Book shoulder physiotherapy in Southampton by calling us on 023 8218 2416

FAQs – Shoulder Pain and Rotator Cuff Injuries

How long does it take to heal shoulder pain and rotator cuff injuries?

It depends, but with the right treatment, it may take several weeks, and sometimes even a few months. Not all patients respond well to conservative, first-line treatment.

Can a rotator cuff tear heal on its own?

Well, it depends. Tears tend to get bigger in time. However, pain associated with tears may be successfully treated by a combination of physiotherapy, shockwave, and, if required, steroid injections.

How expensive is a shoulder scan?

It depends on where you live and where you are planning to have it done. London and private hospital prices will be much higher. An ultrasound scan for the shoulder may cost between £100 and £400, and MRI may cost between £250 – £700.

Can you scan my shoulder?

We offer physiotherapy, which scanning is an integral part of, and yes, we can provide this service and the report afterwards. Please call with further inquiries.

How long is the shoulder scan?

It depends on where and what scan you are having. The longest is an MRI, as there is some preparation involved, and you need to go to an appointment in the hospital. Much less time is required for an X-ray or an ultrasound scan; usually, 30 minutes is sufficient.

References

Aaron, D., Patel, A., Kayiaros, S., Calfee, R., (2011). Four Common Types of Bursitis: Diagnosis and Management. Journal of American Academy of American Surgeons, 19(6), 359-367. Four Common Types of Bursitis: Diagnosis and Management : JAAOS – Journal of the American Academy of Orthopaedic Surgeons (lww.com)

Caekebeke P, Schenkels E, Bell SN, van Riet R. Distal Biceps Provocation Test. J Hand Surg Am. 2021 Aug;46(8):710.e1-710.e4. doi: 10.1016/j.jhsa.2020.12.012. Epub 2021 Mar 20. PMID: 33757665.

Knipe, H., (2022, 13 October). Subacromial-subdeltoid bursitis. https://radiopaedia.org/articles/subacromial-subdeltoid-bursitis?lang=gb

Lewis, J. S. (2011). Subacromial impingement syndrome: a musculoskeletal condition or a clinical illusion? Physical Therapy Reviews16(5), 388–398. https://doi.org/10.1179/1743288X11Y.0000000027

Vishwanathan K, Soni K. Distal biceps rupture: Evaluation and management. J Clin Orthop Trauma. 2021 May 20;19:132-138. doi: 10.1016/j.jcot.2021.05.012. PMID: 34099972; PMCID: PMC8167284.

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