• Shoulder pain typically elicited with a painful arc between 60°-120° abduction

Patient Profile

• From ca. 15 -50 years
• Male=female
• Overhead workers and overhead athlete
• ca. 10% of the population affected

Pathophysiology

The evidence towards an impingement of the subacromial structures is lacking, and we have more and more evidence of a more intrinsic/tendinous origin of the pain.

RCRSP describes symptoms of pain and weakness related to the rotator cuff when loaded or moved.

Peripheral nociceptive tendinopathic pain with possible inflammatory component in the acute stage. No definitive cause. Irritation due to mechanical factors

Course

Acute: can display typical inflammatory symptoms – burning, localized pain paired with night pain; signs of inflammation; small active movements are painful

Subacute: markedly direction- and movement specific; mainly abduction & internal rotation, sometimes flexion. PROM with humeral head centered mostly pain free

Aggravating

Overhead activities (reaching, sports, etc.)

Easing

All other activities, rest

24 Hour

Correlates with activities

History

Long history without trauma. Could develop after traumatic RC-tear. Younger patients associate symptoms with overhead work/sports/activities. Symptoms present long before first consultation with a health professional

• Localized
• Deep
• Stinging
• Impinging
• Clear on-off characteristic
• Painful Arc 60°-120°
• Painful end of range
• Acute: VAS 8-10
• Subacute: VAS 6-8
• Movement and direction specific
• Mainly GH flexion, abduction, internal rotation

Physical Examination

Inspection
Scapular dyskinesis, possibly elevated/depressed shoulders. Protracted and internally rotated humerus

Functional Assessment
Patient can functionally show when symptoms occur

Active Examination
Flexion, abduction (painful arc), internal rotation painful

Passive Examination
Limited PROM in ext/int rotation, Joint play GH: hyper- or hypomobile. Centralizing humeral head during PROM might reduce pain

Special Tests

Differential Diagnosis

1. Frozen shoulder
2. Shoulder instability
3. Traumatic subluxation
4. Humeral fracture
5. RC-Tears (large)
6. Glenohumeral arthritis
7. Ligament injuries (Tossi II-III)
8. TOS

Strategy

Conservative treatment based on the patients level of irritability

Interventions

• Decrease load on affected structures; glenohumeral joint, T-spine, and first rib mobilizations
• Rotator cuff, scapular muscle strengthening
• Sports-specific interventions (e.g. throwing)
• Stretching of shortened muscles

Example of exercises for high irritability from this course

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