The most common cause of shoulder pain is rotator cuff tendinitis.
Repetitive movements of the shoulder, especially overhead movements, can cause micro traumas that lead to tendon fatigue and tendinitis.
Who develops rotator cuff problems?
Athletes, for one. It is not uncommon in those involved in tennis, racketball, baseball, martial arts, weightlifting and crossfit. Workers for another. Risky occupations include carpentry, painting, assembly work, and construction. Others have developed rotator cuff issues simply by sleeping regularly on their side, on the shoulder. Other cases sometimes seem to have no clear cause.
Often, the earliest symptom is a dull ache around the outside tip of the shoulder. The most common tendon affected is the supraspinatus, and this area is close to the tendinous insertion on the humerus. The pain can get worse over time as you push, pull, reach overhead or lift your arm. As the problem progresses, other rotator cuff tendons can be affected. There will generally be a loss in the shoulder’s range of motion.
The rotator cuff comprises four muscles, listed below, each with a tendon that attaches on the humerus. These muscles work together to stabilize the joint, rotate the shoulder and move the arm. I list them below.
1) The supraspinatus. This muscle has been mentioned above. If the tendinitis is allowed to progress, it can develop into impingement syndrome and even tearing of the tendon. I have a separate article for impingement syndrome on my website and invite you to read it. At times, the bursa in this area will also be inflamed.
2) The subscapularis. This is commonly affected in throwing and racket sports and causes pain on the front of the shoulder.
3) and 4) The infraspinatus and teres minor. Also common in throwing and racket sports. The pain is on the back of the shoulder. The onset can be acute. A muscle pull can be felt at the time of injury, and the pain and stiffness will be noticeable the next day. Another name for injuries to these two muscles is “thrower’s shoulder.”
How do we treat the rotator cuff?
Through physical examination and history taking, we can determine which rotator cuff tendons and muscles are affected. Below is how I like to treat it.
- Treating local areas with acupuncture—the areas close to where the tendons attach to the humerus. This directly stimulates healing of the tendons.
- Releasing trigger points in the muscles of the rotator cuff and shoulder girdle. There are often muscle imbalances that contribute to rotator cuff injury, and it is important to loosen the tight muscles and strengthen the weak ones. Trigger point therapy not only relieves pain, it also relaxes tight muscles.
- Activating energy flow through the acupuncture meridians that traverse the shoulder area as well as balancing the energy of the whole body. This strategy, derived from traditional acupuncture, in itself relieves pain and also facilitates the healing process.
- Using manual myofascial release techniques when appropriate to further correct muscular imbalances.
How many treatments?
Generally, the patient will feel some relief and increase in range of motion over the course of 2-4 treatments in a two-week period. More significant treatment can occur in 6-8 treatments over a 3-4 week period. If a partial-thickness tear has occurred in one of the tendons, more treatments might be required. Such tears are more common among the 40 and over crowd.