{"id":5896,"date":"2021-06-01T13:59:23","date_gmt":"2021-06-01T11:59:23","guid":{"rendered":"https:\/\/www.physiotutors.com\/?post_type=clinical_pattern&#038;p=5896"},"modified":"2024-03-04T12:01:54","modified_gmt":"2024-03-04T11:01:54","slug":"rotator-cuff-related-shoulder-pain","status":"publish","type":"clinical_pattern","link":"https:\/\/www.physiotutors.com\/clinical-patterns\/rotator-cuff-related-shoulder-pain\/","title":{"rendered":"Rotator Cuff Related Shoulder Pain"},"featured_media":5899,"template":"","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":""},"tracking_tag":[2193],"class_list":["post-5896","clinical_pattern","type-clinical_pattern","status-publish","has-post-thumbnail","hentry","tracking_tag-shoulder"],"acf":{"free_access":"unfree","app_link":"https:\/\/app.physiotutors.com\/add-ons\/a829b875-9795-41a4-bf2d-f6e71dcc12d8","sections":[{"acf_fc_layout":"page-header-detail-page","background":{"background_image":5898,"background_image_alt_text":"Rotator Cuff Related Shoulder Pain"},"heading":"Rotator Cuff Related Shoulder Pain","subheading":"RCRSP","content_editor":"","button_type":"internal_link","button_label":"","button_style":"button-one","button_internal_link":"","button_anchor":"","button_url":"","button_file":null,"label":""},{"acf_fc_layout":"submenu","links":[{"button_type":"anchor","button_label":"Body Chart","button_internal_link":null,"button_anchor":"section-number-4","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Background Information","button_internal_link":null,"button_anchor":"section-number-4","button_url":"","button_file":null},{"button_type":"anchor","button_label":"History & Physical Examination","button_internal_link":null,"button_anchor":"section-number-5","button_url":"","button_file":null},{"button_type":"anchor","button_label":"Treatment","button_internal_link":null,"button_anchor":"section-number-6","button_url":"","button_file":null},{"button_type":"anchor","button_label":"References","button_internal_link":null,"button_anchor":"section-number-8","button_url":"","button_file":null}],"dropdown_label":"Go to","button_right":{"button_type":"internal_link","button_label":"","button_style":"button-link-one","button_internal_link":"","button_anchor":"","button_url":"","button_file":null},"button_description":""},{"acf_fc_layout":"content-content","section_options":{"vertical_alignment":"top","column_right_box":false,"column_left_width":"col-12 col-lg-4 offset"},"column_left":{"content_editor":"<h2 class=\"heading-four\">Body Chart<\/h2>"},"column_right":{"content_editor":"<img class=\"alignnone wp-image-5900 size-full\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2021\/06\/SAPS-Pain-Diagram.png\" alt=\"Saps pain diagram\" width=\"1298\" height=\"1136\" \/>\r\n<ul>\r\n \t<li>Shoulder pain typically elicited with a painful arc between 60\u00b0-120\u00b0 abduction<\/li>\r\n<\/ul>"}},{"acf_fc_layout":"content-content","section_options":{"vertical_alignment":"top","column_right_box":false,"column_left_width":"col-12 col-lg-4 offset"},"column_left":{"content_editor":"<h2 class=\"heading-four\">Background Information<\/h2>"},"column_right":{"content_editor":"<h3>Patient Profile<\/h3>\r\n<ul>\r\n \t<li>From ca. 15 -50 years<\/li>\r\n \t<li>Male=female<\/li>\r\n \t<li>Overhead workers and overhead athlete<\/li>\r\n \t<li>ca. 10% of the population affected<\/li>\r\n<\/ul>\r\n<h3><\/h3>\r\n<h3>Pathophysiology<\/h3>\r\nThe 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.\r\n\r\nRCRSP describes symptoms of pain and weakness related to the rotator cuff when loaded or moved.\r\n\r\nPeripheral nociceptive tendinopathic pain with possible inflammatory component in the acute stage. No definitive cause. Irritation due to mechanical factors\r\n<h3>Course<\/h3>\r\nAcute: can display typical inflammatory symptoms \u2013 burning, localized pain paired with night pain; signs of inflammation; small active movements are painful\r\n\r\nSubacute: markedly direction- and movement specific; mainly abduction &amp; internal rotation, sometimes flexion. PROM with humeral head centered mostly pain free\r\n\r\n<strong>Aggravating<\/strong>\r\n\r\nOverhead activities (reaching, sports, etc.)\r\n\r\n<strong>Easing<\/strong>\r\n\r\nAll other activities, rest\r\n\r\n<strong>24 Hour<\/strong>\r\n\r\nCorrelates with activities"}},{"acf_fc_layout":"content-content","section_options":{"vertical_alignment":"top","column_right_box":false,"column_left_width":"col-12 col-lg-4 offset"},"column_left":{"content_editor":"<h2 class=\"heading-four\">History &amp; Physical Examination<\/h2>"},"column_right":{"content_editor":"<h3>History<\/h3>\r\nLong 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\r\n<ul>\r\n \t<li>Localized<\/li>\r\n \t<li>Deep<\/li>\r\n \t<li>Stinging<\/li>\r\n \t<li>Impinging<\/li>\r\n \t<li>Clear on-off characteristic<\/li>\r\n \t<li>Painful Arc 60\u00b0-120\u00b0<\/li>\r\n \t<li>Painful end of range<\/li>\r\n \t<li>Acute: VAS 8-10<\/li>\r\n \t<li>Subacute: VAS 6-8<\/li>\r\n \t<li>Movement and direction specific<\/li>\r\n \t<li>Mainly GH flexion, abduction, internal rotation<\/li>\r\n<\/ul>\r\n<h3><\/h3>\r\n<h3>Physical Examination<\/h3>\r\n<strong>Inspection\r\n<\/strong>Scapular dyskinesis, possibly elevated\/depressed shoulders. Protracted and internally rotated humerus\r\n\r\n<strong>Functional Assessment\r\n<\/strong>Patient can functionally show when symptoms occur\r\n\r\n<strong>Active Examination<\/strong>\r\nFlexion, abduction (painful arc), internal rotation painful\r\n\r\n<strong>Passive Examination\r\n<\/strong>Limited PROM in ext\/int rotation, Joint play GH: hyper- or hypomobile. Centralizing humeral head during PROM might reduce pain\r\n\r\n<strong>Special Tests\r\n<\/strong>\r\n\r\n[embed]https:\/\/youtu.be\/UErH4NUsDWQ[\/embed]\r\n\r\n&nbsp;\r\n<h3>Differential Diagnosis<\/h3>\r\n<ol>\r\n \t<li>Frozen shoulder<\/li>\r\n \t<li>Shoulder instability<\/li>\r\n \t<li>Traumatic subluxation<\/li>\r\n \t<li>Humeral fracture<\/li>\r\n \t<li>RC-Tears (large)<\/li>\r\n \t<li>Glenohumeral arthritis<\/li>\r\n \t<li>Ligament injuries (Tossi II-III)<\/li>\r\n \t<li>TOS<\/li>\r\n<\/ol>"}},{"acf_fc_layout":"content-content","section_options":{"vertical_alignment":"top","column_right_box":false,"column_left_width":"col-12 col-lg-4 offset"},"column_left":{"content_editor":"<h2 class=\"heading-four\">Treatment<\/h2>"},"column_right":{"content_editor":"<h3>Strategy<\/h3>\r\n<span style=\"font-size: 16px;\">Conservative treatment based on the patients level of irritability<\/span>\r\n\r\n&nbsp;\r\n<h3><strong>Interventions<\/strong><\/h3>\r\n<ul>\r\n \t<li>Decrease load on affected structures; glenohumeral joint, T-spine, and first rib mobilizations<\/li>\r\n \t<li>Rotator cuff, scapular muscle strengthening<\/li>\r\n \t<li>Sports-specific interventions (e.g. throwing)<\/li>\r\n \t<li>Stretching of shortened muscles<\/li>\r\n<\/ul>\r\n<strong>Example of exercises for high irritability from <a href=\"https:\/\/study.physiotutors.com\/course\/rotator-cuff-related-shoulder-pain\/\">this course<\/a><\/strong>\r\n\r\n[embed]https:\/\/www.youtube.com\/watch?v=eOfk_A00f0Y[\/embed]"}},{"acf_fc_layout":"cta-big","heading":"Download the new Physiotutors App","subheading":"PHYSIOTUTORS APP","content_editor":"Are you ready for a learning revolution?\r\n\r\nExperience the Physiotutors content you love in our new app.","form_toggle":false,"form":"92","number_of_buttons":"one","button_1":{"button_1_button_type":"internal_link","button_1_button_label":"DOWNLOAD NOW","button_1_button_style":"button-two","button_1_button_internal_link":16662,"button_1_button_anchor":"","button_1_button_url":"","button_1_button_file":null},"button_2":{"button_2_button_type":"internal_link","button_2_button_label":"","button_2_button_style":"button-one : 1","button_2_button_internal_link":null,"button_2_button_anchor":"","button_2_button_url":"","button_2_button_file":null},"image":17728,"image_alt_text":"","overlay":false},{"acf_fc_layout":"content-content","section_options":{"vertical_alignment":"top","column_right_box":false,"column_left_width":"col-12 col-lg-4 offset"},"column_left":{"content_editor":"<h2 class=\"heading-four\">References<\/h2>"},"column_right":{"content_editor":"<ol>\r\n \t<li>Mayer, C.a.S., W, 100 Krankheitsbilder in der Physiotherapie. 2011, Heidelberg: Springer Medizin.<\/li>\r\n \t<li>Sher, J.S., et al., Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am, 1995. 77(1): p. 10-5.<\/li>\r\n \t<li>Jost, B., et al., MRI findings in throwing shoulders: abnormalities in professional handball players. Clin Orthop Relat Res, 2005(434): p. 130-7.<\/li>\r\n \t<li>Ellenbecker, T.S. and A. Cools, Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review. Br J Sports Med, 2010. 44(5): p. 319-27.<\/li>\r\n \t<li>Tennent, T.D., W.R. Beach, and J.F. Meyers, A review of the special tests associated with shoulder examination. Part I: the rotator cuff tests. Am J Sports Med, 2003. 31(1): p. 154-60.<\/li>\r\n \t<li>Kibler, W.B., et al., Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the 'Scapular Summit'. Br J Sports Med, 2013. 47(14): p. 877-85.<\/li>\r\n \t<li>Scaia, V., D. Baxter, and C. Cook, The pain provocation-based straight leg raise test for diagnosis of lumbar disc herniation, lumbar radiculopathy, and\/or sciatica: a systematic review of clinical utility. J Back Musculoskelet Rehabil, 2012. 25(4): p.215-23.<\/li>\r\n \t<li>Michener, L.A., et al., Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement. Arch Phys Med Rehabil, 2009. 90(11): p. 1898-903.<\/li>\r\n \t<li>Cook, C.a.H., E, Orhtopedic Physical Examination Tests. An evidence based approach. 2nd ed. 2013, New Jersey: Pearson Education.<\/li>\r\n \t<li>Michener, L.A., M.K. Walsworth, and E.N. Burnet, Effectiveness of rehabilitation for patients with subacromial impingement syndrome: a systematic review. J Hand Ther, 2004. 17(2): p. 152-64.<\/li>\r\n<\/ol>"}}]},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Rotator Cuff Related Shoulder Pain - Physiotutors<\/title>\n<meta name=\"description\" content=\"Learn about the diagnosis, prognosis and treatment of Rotator Cuff Related Shoulder Pain in our Clinical Pattern for Physiotutors Members\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.physiotutors.com\/clinical-patterns\/rotator-cuff-related-shoulder-pain\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Rotator Cuff Related Shoulder Pain - Physiotutors\" \/>\n<meta property=\"og:description\" content=\"Learn about the diagnosis, prognosis and treatment of Rotator Cuff Related Shoulder Pain in our Clinical Pattern for Physiotutors Members\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.physiotutors.com\/clinical-patterns\/rotator-cuff-related-shoulder-pain\/\" \/>\n<meta property=\"og:site_name\" content=\"Physiotutors\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/facebook.com\/physiotutors\" \/>\n<meta property=\"article:modified_time\" content=\"2024-03-04T11:01:54+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2021\/06\/SAPS-featured-image.png\" \/>\n\t<meta property=\"og:image:width\" content=\"560\" \/>\n\t<meta property=\"og:image:height\" content=\"466\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:site\" content=\"@physiotutors\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.physiotutors.com\\\/clinical-patterns\\\/rotator-cuff-related-shoulder-pain\\\/\",\"url\":\"https:\\\/\\\/www.physiotutors.com\\\/clinical-patterns\\\/rotator-cuff-related-shoulder-pain\\\/\",\"name\":\"Rotator Cuff Related Shoulder Pain - 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