Shoulder Pain and Rotator Cuff Tendinosis

We treat many types of shoulder pain at CCSR. Shoulder pain is usually caused by vigorous repetitive arm use (such as swimming or golfing), overhead lifting, or any activities that hold your arms above your head. Through motions like these, the shoulder muscles tighten, and will eventually load onto their attached tendons. The tendons then become in-flamed, which contracts the shoulder muscles further into the shoulder joint and thereby causes further tightness. So, when a person raises an arm, his or her shoulder can im-pinge (pinch) the shoulder bursa or the tendon. This can lead to either bursitis (inflammation of the bursa) or tendinitis (inflammation of the tendon). It left untreated, tendinitis (which is temporary) will progress into tendinosis: painful de-generation of the tendons in the shoulder.
Rotator cuff tendinosis usually presents with a deep ache radiating from the outer arm to several centimetres below the top of the shoulder. This pain may interfere with sleep, and often awakens people from sleep with a nagging pain in their upper arm. Raising arms overhead or reaching behind the body tends to aggravate the symptoms. Usually, patients will experience significant pain after completing a repetitive motion activity but will not normally be affected while complet-ing it. For example, a patient may feel a bit of pain while warming up for a game of squash, but this will improve as the muscles warm up and the patient may be pain-free during his or her game. After the game, however, the patient will likely experience lots of pain and decreased function of the shoulder.
The rotator cuff is a group of four muscles and tendons that control arm rotation and elevation. It works with the deltoid muscle to provide strength, stability, and motion to the shoulder for all activities that involve the shoulder: full-arm movement, lifting, throwing, pushing, pulling, swinging, etc. Most sports include some level of shoulder movement, as well as day-to-day activities: food preparation, cleaning, driving, etc. Unfortunately, most of these activities include repetitive movements, and repetitive strain is at the root of all rotator cuff injuries. The rotator cuff is sandwiched between two bones, which means that repetitive motion of these bones can inflame the tendons and muscles in the rotator cuff, eventually wearing away at the collagen in this area. Because all shoulder injuries are the result of inflammation, treat-ment always aims to reduce inflammation and regrow collagen.