The supraspinatus muscle rests on top of the shoulder. Its tendon travels under the bone on the outside of the shoulder (the acromion). This tendon is the one most often injured because of its position between the bones. As the tendon becomes inflamed (sore and swollen), it can become pinched between the 2 bones. The sac of fluid that cushions the tendon can also be damaged.

Arthritis:
Arthritis causes progressive joint pain, tenderness, swelling and stiffness. Both rheumatoid arthritis and osteoarthritis can affect the shoulder joint.

Rotator cuff disorders:
The rotator cuff is a group of muscles and tendons that help to move the shoulder and hold the joint in place. Rotator cuff disorders result from inflammation or damage to the rotator cuff muscles or tendons, or inflammation of the subacromial bursa (which is a fluid-filled pad that sits under the highest part of the shoulder). The inflammation can be caused by general wear and tear that occurs with age, activities that require constant or repetitive shoulder motion (especially above shoulder level), heavy lifting, trauma, or poor posture. Serious injuries and untreated inflammation of the tendons can cause the rotator cuff to tear.

The pain associated with rotator cuff problems is normally felt at the front or on the outside of the shoulder, particularly when you raise your arm or lift something above your head. You may also notice the pain more when lying in bed. Severe injuries can cause weakness of the shoulder muscles, restricted shoulder movement and continuous pain.

Diagnose:
Your doctor may be able to determine the cause of your pain based on your symptoms and a physical examination. Where the pain is felt, both at rest and when moving the shoulder, is a clue to the cause of the shoulder pain. Your doctor will also test your shoulder strength and the range of movement in your shoulder joint.

You may also need to have an X-ray, or other scans, such as an ultrasound scan or MRI. Sometimes, an arthroscopy is needed. In this test, your doctor can look inside the shoulder joint using a small telescopic instrument that has a camera on the end.

Treatments:
In addition to relieving pain, treatment is aimed at restoring mobility in your shoulder joint. The choice of treatment depends on the shoulder problem.

Pain relievers such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) are often used as an initial treatment for shoulder pain. Another simple way of easing shoulder pain is by applying a cold pack to your shoulder. Cold packs can reduce inflammation, and are most helpful when applied for the first few days following a shoulder injury. After that, you can switch to using a heat pack; intermittent applications of heat can help relax the shoulder muscles.

You should also rest the shoulder for a couple of days after most injuries, and if you have dislocated your shoulder, you may need to rest your arm in a sling or splint for several weeks after the joint has been manipulated back into place. However, with most shoulder problems it isn’t a good idea to rest for too long. While you should avoid strenuous activities and lifting heavy objects, you should still move your shoulder to help make sure that you regain full use of the joint. By returning to your normal activities as soon as possible (within the limits of disability and pain), you can help prevent the shoulder joint from stiffening up.

Depending on the cause of your shoulder problem, corticosteroid injections may be given to relieve the pain in the short term. The corticosteroid, which is often mixed with a local anaesthetic, reduces inflammation and allows you to move the shoulder more comfortably.

Because most people improve with the above treatments, only about 10 per cent of people with shoulder problems will need to be treated with surgery. People with shoulder instability or rotator cuff problems that are not responding to less invasive treatments may benefit from an operation, and shoulder joint replacement may be considered for people with arthritis.

The photo on the left is a partial rotator cuff tear.
The photo on right is after surgery to clean up the tissue from the small tear.
This is supposedly what I had, a small tear.

Physiotherapy can help improve shoulder strength and flexibility as well as relieve the pain associated with most shoulder problems. Physiotherapists use a variety of different therapies, including massage, ultrasound therapy, laser therapy and transcutaneous electrical nerve stimulation (TENS) — a therapy that uses mild electrical currents to treat pain. Taping the joint can also help stabilise it and reduce pain during activities.

Physiotherapists can also teach special rehabilitation exercises to stretch and strengthen the rotator cuff muscles of the shoulder. Exercises that improve your shoulder’s range of movement help reduce the stiffness that occurs after a period of immobility. Range of motion exercises may be followed by resistance exercises and weight training to strengthen the muscles.