My shoulder hurts. What should I do?

Rotator cuff tendinopathy

Rotator cuff tendinopathy usually presents as shoulder pain that can interfere with certain arm movements. The rotator cuff is made up of four muscles—the supraspinatus, the infraspinatus, the teres minor, and the subscapular—whose role is to both move and stabilize the shoulder joint.

Tendinopathy or tendinitis?

Tendinopathy is a generic word that means damage to a tendon, the structure that attaches a muscle to a bone. Tendinopathies can be divided into two categories: tendinitis and tendinosis.

Tendinitis is the inflammation of a tendon in the first 3-4 days after an injury. It’s considered an acute injury.

Tendinosis, on the other hand, is a chronic injury, meaning the pain persists for more than a few days. In that case, the inflammation is no longer the cause of the pain, which can be due, for example, to a partial tendon tear that happens over time, or to a catching between different parts of the shoulder joint, which pinches the tendon during certain movements.

In summary, rotator cuff tendinopathy is a shoulder injury that can be either acute (tendinitis) or chronic (tendinosis).

Magnetic resonance imaging

Magnetic resonance imaging (MRI) is a diagnostic test that’s often used by doctors. It’s important to realize that even though an MRI can pinpoint the anatomical structures affected, that doesn’t automatically make them the source of your pain. Several studies have shown that a structure can be damaged (for example, a partial tendon tear) without causing any pain. Over the years, it is quite normal for some people to develop micro-tears, due to their anatomy, their posture, or specific activities.

For that reason, the best indicator of a shoulder problem isn’t the presence or absence of micro-tears, but rather pain. If you’re in pain, it’s important that you do something to relieve it and prevent further damage to your tendon, so you can get back to your normal activities.

What to do?

To relieve the shoulder pain associated with chronic rotator cuff tendinopathy (or tendinosis), you can try applying heat for 15-20 minutes, once or twice a day. Applying heat relaxes your muscles, which can help to relieve the pain. Keep a close eye on your reaction. If heat makes your shoulder more sensitive, stop applying it.

You can also download this free exercise program:

How can physiotherapy help?

If you’re suffering from rotator cuff tendinopathy, the physiotherapist will assess the range of motion and strength of the affected shoulder, and any other region that could be contributing to the problem, such as your cervical or thoracic spine. It’s possible that your shoulder pain may be partially due to stiffness in your spine. The physiotherapist will also be able to tell whether there’s any catching or stiffness during shoulder movements.

A physiotherapy follow-up assesses the person’s complete biomechanics in order to identify and treat all the factors contributing to the problem.

In the case of chronic rotator cuff tendinopathy (tendinosis), it’s important to start an exercise program to move and strengthen the shoulder muscles. Muscle activation is essential and a much better option than rest for reducing your pain. It will also let you get back to your regular activities as soon as possible.