The shoulder is composed of several joints, tendons and muscles that come together to allow for a wide range of movement. But because of so many different structures that make it up, the shoulder is particularly vulnerable to a number of problems. Injuries of the rotator cuff are the most common causes that cause pain in the shoulder.

Usually, the tendinopathy of the rotator cuff causes pain and limitation of movement when lifting the arm and moving it backwards, as happens during dressing or when closing the bra. Also, the pain can occur when sleeping on the affected side.

Tendinopathy of the rotator cuff is often also known as supraspinatus muscle tendinopathy, since it most commonly affects the supraspinatus muscle (one of the rotator cuff muscles).

The rotator cuff is a tendinous blade that covers the anterior, upper and posterior sides of the shoulder joint capsule. It is composed of the tendons of 4 different muscles, namely:

1. supraspinatus muscle

2. infraspinatus muscle

3. small round muscle

4. subscapularis muscle

One of the muscles of the rotator cuff, the supraspinatus muscle, is more vulnerable. The tendon of the supraspinatus muscle attaches to the humerus (arm bone) and can become overworked or degenerated due to frequent arm movement, which can cause tendinopathy (inflammation of the tendon). By the action of the rotator cuff, the humeral head is maintained in the shoulder joint and ensures the rotational and lifting movements of the arm. The dysfunctionality of the rotator cuff allows the superior migration of the humeral head (the head of the humerus bone which is the only bone of the arm) and the tendons of the muscles that make up the rotator cuff can break if they are overworked or injured.

The bursa, a fluid sac with a lubricating role, which is located between the rotator cuff and the acromion bone (bone that is in the extension of the shoulder blade) allows the tendons of the muscles to move freely with the movement of the arm. When the tendons are damaged or injured, the bursa will become inflamed and painful, a condition known as subacromial bursitis.

There are several different causes that contribute to the inflammation of the tendons of the rotator cuff, namely:

➢ arthritis of the acromioclavicular joint (the joint between the acromion bone and the clavicula. The acromion bone is the extension of the shoulder blade)

➢ excessive use of the shoulder in sports

➢ deficient posture

➢ degenerative changes around the shoulder joint

Untreated, tendinopathy can lead to partial rupture of the tendons of the rotator cuff muscles.

Sports or daily activities which cause or aggravate the pain, will be interrupted for a period of time. The most problematic sport for the shoulder are golf and those that use the racket (tennis, squash), as well as weightlifters.

Nonsteroidal anti-inflammatory drugs can help reduce pain in the affected area. But they are recommended for short periods of time, 7-14 days maximum. If after 14 days there is no reduction in pain, it should be discussed with the doctor or therapist. In this case a local injection of anesthetic and cortisone could have beneficial effects on the pain. Cortisone is a highly effective anti-inflammatory drug. By injecting it around the acromioclavicular joint, inflammation of the supraspinatus tendon can be reduced, which decreases pain and improves the range of movement.

Initially, physical therapy will focus on restoring normal movement in the shoulder joint, stretching exercises being extremely useful to this extent. If there is also a limitation of the movement of the arms in the back, it is possible that a tightness has developed in the posterior capsule of the shoulder joint. In these cases as well, certain stretching exercises of the posterior capsule can be quite effective, both for improving movement as well as for relieving pain.

As the pain improves, the recovery program will continue with exercises to tone (strengthen) the muscles of the rotator cuff.

➢ repetitive activities that involve lifting the arms predispose to injuries of the rotator cuff

➢ the pain that occurs when throwing a ball, may suggest the existence of an early stage of tendinopathy

➢ shoulder pain that is present both during various activities and at rest could also suggest a tendinopathy of the rotator cuff