According to a systematic review published in 2022, shoulder pain affects about 1 in 25 people per year globally (1), with “rotator-cuff related shoulder pain” considered to be the biggest contributor to this statistic (2).
This broad diagnosis, meant to describe almost any soft-tissue issue in and around the shoulder area, can be daunting to navigate. The high prevalence of rotator-cuff related shoulder pain has spurred not only research and innovation to better understand and deal with the problem, but has also inevitably led to a mountain of information and opinions published online — and not all of it may be of the highest quality…or the most relevant to your shoulder.
![rotator cuff pain](https://b1481684.smushcdn.com/1481684/wp-content/uploads/2-3-819x1024.png?lossy=1&strip=1&webp=1)
Understanding what’s happening
Generally speaking, most rotator-cuff related shoulder pain issues can be divided into 2 categories: traumatic (directly linked to a specific injury) or degenerative (linked to normal wear and tear, somewhat akin to the development of wrinkles on the skin), with degenerative conditions being much more common. These degenerative conditions can include pathoanatomical diagnoses such as tears, tendinopathies, impingement syndromes, calcifications and bursitis, to name a few. Traumatic injuries, for the most part, have well-studied and efficient rehabilitation protocols in place, involving anything from a simple exercise program to surgical repair of affected structures. The waters are much murkier, however, when it comes to treating degenerative rotator-cuff related shoulder pain.The allure of more radical interventions promising rapid results is strong, and in a few, lucky cases, can be effective. When dealing with degenerative rotator-cuff related shoulder pain, however, it’s important to consider the facts.
Should I see a physiotherapist for rotator-cuff pain?
A physiotherapist is definitely well qualified to help sort-out most degenerative rotator-cuff related shoulder pain issues. It’s important to understand that your body is fabulously designed, and is made to adapt to and accommodate almost any demand placed on it. More often than not, offering your shoulder a bit of support via strengthening, and a bit of space via stretching and posture work, will do the trick in restoring you back to where you were (or better!), regardless the underlying changes in your tissues. This does take some time and commitment on your behalf, but it is a strategy that has been proven effective in the literature (5). A physiotherapist can help create the right program for you and progress it when necessary.
![rotator cuff](https://b1481684.smushcdn.com/1481684/wp-content/uploads/1-2-819x1024.png?lossy=1&strip=1&webp=1)
Should I get an injection?
Corticosteroid injections such as cortisone are commonly brought up as a treatment option. “Should I get an injection?” “Would cortisone help?” are common questions posed to physiotherapists. It is important to note that as physiotherapists, we cannot give pharmacological advice (this is outside of our scope of practice), but we can help inform a shared decision-making process. And we can do so by considering the evidence.
A 2017 study looking at the efficacy of corticosteroid injections in rotator cuff tendon pain found that there is only a small and temporary improvement in pain from 4 to 8 weeks post-injection, and this is for only 1 in 5 patients who have been injected (3). Meaning that, should you (and your doctor) choose to go this route, you should do so knowing you likely only have a 20% chance of obtaining mild relief for 1-2 months. The authors of this study concluded that corticosteroid injections are not a quick fix and should be kept to a minimum.
Should I have surgery?
This is another question many have asked their physiotherapist. Again, as physiotherapists, we are not qualified to make this decision. This is a privilege held by you, the patient, and your doctor. We can once more, however, present you with the best evidence available. Currently, there several studies stating that shoulder exercises are as effective as surgery when dealing with degenerative rotator-cuff related pain, both in the short and long term (4,5). And when considering the cost of surgery, post-surgical rehabilitation implications and the inherent risk that comes along with any surgery, the exercise route should be prioritized.
So, what do I do?
Of course, the best course of action is the one you ultimately feel most comfortable with.Take the time to talk to your healthcare practitioner and make sure you clearly understand the expectations and implications of your treatment of choice. Play an active role in the decision-making process regarding your shoulder pain, and get ready to wave that pain in the cuff “Goodbye”!
About Jasmine Pollice
Jasmine graduated with her B.Sc. in Physical Therapy from McGill University in 2006. She quickly gravitated towards orthopedic physiotherapy, and after a few years, developed a passion for manual therapy. Jasmine obtained her certification as a Fellow of the Canadian Academy of Manipulative Physical Therapists (FCAMPT) in 2016. Jasmine continued her post-graduate education in 2018, graduating from University of Western Ontario with a Master’s of Clinical Science in Advanced Healthcare Practice.After a brief stint working in downtown Calgary in 2018, Jasmine returned to Montreal, and is currently co-owner of Physio ProForm. Her specializations include treating chronic pain, sports injuries, peri-partum care, headaches and temporo-mandibular joint (jaw) dysfunctions.
References
Lucas, J et al.A systematic review of the global prevalence and incidence of shoulder pain. BMC Musculoskeletal Disorders23, 1073 (2022). https://doi.org/10.1186/s12891-022-05973-8
Sambandam SN, Khanna V, Gul A, Mounasamy V. Rotator cuff tears: An evidence based approach. WorldJ Orthop.2015 Dec 18;6(11):902-18.
Mohamadi A, Chan JJ, Claessen FM, Ring D, Chen NC. Corticosteroid Injections Give Small and Transient Pain Relief in Rotator Cuff Tendinosis: A Meta-analysis. Clin Orthop Relat Res. 2017 Jan;475(1):232-243.doi: 10.1007/s11999-016-5002-1. Epub 2016 Jul 28.PMID: 27469590; PMCID: PMC5174041.
Ketola S, Lehtinen JT, Arnala I. Arthroscopic decompression not recommended in the treatment ofrotator cuff tendinopathy: a final review of a randomised controlled trial at a minimum follow-up of tenyears. Bone Joint J. 2017 Jun;99-B(6):799-805. doi: 10.1302/0301-620X.99B6.BJJ-2016-0569.R1. PMID:28566400.
Haahr JP, Østergaard S, Dalsgaard J, Norup K, Frost P, Lausen S, Holm EA, Andersen JH. Exercises versusarthroscopic decompression in patients with subacromial impingement: a randomised, controlled studyin 90 cases with a one year follow up. Ann Rheum Dis. 2005 May;64(5):760-4. doi:10.1136/ard.2004.021188. PMID: 15834056; PMCID: PMC1755495.
Lewis, J. Rotator Cuff Related Shoulder Pain-An Update. Webinar produced for the Canadian Physiotherapy Association. 2023 August.