Rotator cuff is the commonly used name for the shoulder muscle complex, the most mobile joint in the human body.
This joint is as complex as it is delicate, and is part of the list of the joints most prone to injury and deterioration.
The pain triggered by the various pathologies is generically defined as "periarthritis"; however, each clinical picture should require specific and appropriate therapy.
Of all the discomforts, the most frequent one is undoubtedly tendinopathy (tendonitis, calcifications, rupture, etc.), followed by acute injuries, arthrosis and painful radiation that depart from the neck.
The rotator cuff is made up of 5 joints, 26 muscles, and at least twice as many tendons. It is a very complex structure and the lesion could be located in any of the many locations.
Statistically, the areas of greatest interest are the tendons of the supraspinatus and infraspinatus muscles.
The published material is intended to allow quick access to general advice, suggestions and remedies that doctors and textbooks usually dispense for the treatment of Rotator Cuff Pain; such indications must in no way substitute the opinion of the attending physician or other health specialists in the sector who are treating the patient.
What to do
- Prevention: essential especially when the subject is aware of a family predisposition, has an associated clinical history or recognizes other factors linked to the increased risk (environmental elements).
- Recognition of symptoms: to speed up diagnostic times, the subject must be aware of what “could” be the related symptoms; eg:
- Suffering during:
- Performing specific movements.
- Palpation in specific districts.
- Joint stiffness, first in the morning associated with pain and then constant.
- Sensation of instability, especially during specific gestures and in the most intense cases even at rest.
NB. Function is generally impaired due to muscle weakness and thinning, lengthening and thinning of the tendons.
- In the presence of suggestive symptoms, undergo a general medical examination and subsequently orthopedic with:
- History: functional evaluation (rotator cuff test), palpation, etc.
- Imaging tests (including to rule out other diseases or comorbidities):
- Ultrasound.
- X-ray.
- Magnetic Resonance.
- Lifestyle modification: in part equal to certain preventive measures, it mainly includes:
- Correction of movements that involve the activation of the shoulder and specific muscles-tendons.
- Adjustment of overloads.
- If necessary, correction of the sports-motor technique (for example the back stroke in swimming).
- Choice of the most suitable tools and aids and / or use of automated methods in certain work phases.
- Application of conservative therapy and / or surgery:
- Conservative therapy:
- Discharge of the rotator cuff from potentially noxious stimuli.
- Preventive gymnastics for strengthening the hypotrophic muscles and stretching.
- Cryotherapy or cold therapy: useful in the acute phase, it acts by decreasing inflammation and calming pain.
- If there is a chronic or mild tendon injury, some specialists suggest heat therapy to improve vascularity and facilitate healing (to be avoided in case of acute injury with ruptured vessels).
- Anti-inflammatory drugs (non-steroidal or corticosteroid).
- Medical treatments: useful for reducing inflammation and pain as well as stimulating tissue repair.
- Surgery: used when tendons calcify or rupture, or when other complications are present (bone spurs, compromised ligaments, etc.).
- Preparation for surgery and post-surgical rehabilitation: physiotherapy and strengthening.
- The most commonly used strengthening exercises (to be performed with elastic bands) act on the supraspinatus and on the infraspinatus; they are: lateral raises (controlled movement) combined with exercises of external rotation of the scapula, pulley, vertical row with high grip and T bar.
What NOT to do
- Make use of anabolic steroids by greatly increasing the strength with respect to the resistance of the tendons.
- Neglecting prevention.
- Ignore symptoms that potentially warrant early diagnosis.
- Self-treatment: this does not allow a certain diagnosis and increases the risk of worsening of the disease.
- Do not deepen the medical history by carrying out the imaging investigations.
- Maintain work habits, hobbies, sports activities and, more generally, incorrect or painful ones.
- Carry out strengthening exercises that are harmful to the districts involved:
- For injuries of the supraspinatus muscle and related structures it is necessary to avoid: shoulder press, slow with barbell and slow with dumbbells (front and back), rear lat machine, heavy and violent lateral raises, pulled to the chin.
- For injuries to the infraspinatus muscle and related structures, the following should be avoided: chest press, dumbbell press, flat and inclined bench presses.
- Follow therapy incorrectly or discontinuously (drugs, physiotherapy, medical treatments, etc.).
- Exclude surgery when necessary.
What to eat
There is no diet suitable for the prevention or treatment of rotator cuff injuries. However, the nutritional status can positively or negatively affect the inflammatory status.
- It could be useful to increase the intake of nutrients with a strong anti-inflammatory function:
- Omega 3: they are eicosapentaenoic acid (EPA), docosahexaenoic (DHA) and alpha linolenic (ALA). They have an anti-inflammatory role. The first two are biologically very active and are mainly found in: sardines, mackerel, bonito, sardinella, herring , alletterato, belly of tuna, garfish, seaweed, krill etc. The third is less active, but constitutes a precursor of EPA; it is mainly contained in the fat fraction of certain foods of plant origin and in the oils of: soy, linseed, kiwi seeds, grape seeds etc.
- Antioxidants:
- Vitamins: the antioxidant vitamins are carotenoids (provitamin A), vitamin C and vitamin E. Carotenoids are contained in vegetables and red or orange fruits (apricots, peppers, melons, peaches, carrots, squash, tomatoes, etc.); they are also present in crustaceans and milk. Vitamin C is typical of sour fruit and some vegetables (lemons, oranges, mandarins, grapefruits, kiwis, peppers, parsley, chicory, lettuce, tomatoes, cabbage, etc.). Vitamin E can be found in the lipid portion of many seeds and related oils (wheat germ, corn germ, sesame, kiwi, grape seeds, etc.).
- Minerals: zinc and selenium. The first is mainly contained in: liver, meat, milk and derivatives, some bivalve molluscs (especially oysters). The second is mainly contained in: meat, fish products, egg yolk, milk and derivatives, enriched foods (potatoes, etc.).
- Polyphenols: simple phenols, flavonoids, tannins. They are very rich: vegetables (onion, garlic, citrus fruits, cherries, etc.), fruit and relative seeds (pomegranate, grapes, berries, etc.), wine, oil seeds, coffee, tea, cocoa, legumes and whole grains, etc.
What NOT to Eat
- Eliminate alcohol: they compromise the pharmacological metabolism.
Natural Cures and Remedies
- Static or dynamic stretching: inelastic muscles (particularly if hypertrophic) are more prone to injury and tend to over-strain the tendons during stretching. This is why stretching is considered both preventive and rehabilitative.
- Motor exercises for strengthening: used in conservative therapy, in preparation for surgery and in subsequent rehabilitation. They are particularly useful in shoulder tendonitis where the triggering cause is a reduction in muscle tone which causes distension of the tendons.
ATTENTION! It is inadvisable to force stretch and reinforcement gymnastics excessively; in addition to generating pain, they could favor the rupture of a particularly thinned tendon.
- Cryotherapy: cold therapy is useful in reducing pain and inflammation. It should be performed 2 or 3 times a day. Ice should not be applied directly; on the contrary, it should be placed in a containment bag with water and applied by placing a woolen cloth to protect the skin.
- Heat Therapy: Increases blood flow and can speed up the recovery of a tendon injury. It must not be used in the presence of vascular lesions.
- Braces: of various kinds, they can be useful to limit the movements of the rotator cuff or to support it after surgery.
Pharmacological treatment
The inflammation can cause severe tendinopathies that excessively weaken the tendons and generate calcifications.
Pharmacological treatments for rotator cuff pain are primarily anti-inflammatory.
- Non-steroidal anti-inflammatory drugs (NSAIDs):
- Systemic for oral use: they are more used than topical ones, as the structures of the rotator cuff are difficult to reach through skin application. They are also more powerful than ointments and gels. They may require the use of a gastroprotector . People with liver or kidney disorders are not always able to take them.
- Ibuprofen: e.g. Brufen ®, Moment ®, Spidifen ®, Nurofen ®, Arfen ®, Actigrip fever and pain ® and Vicks fever and pain ®).
- Ketoprofen: for example Arthrosilene ®, Orudis ®, Oki ®, Fastum gel ®, Flexen "Retard" ® and Ketodol ®.
- Diclofenac: for example Dicloreum ®, Deflamat ®, Voltaren Emulgel ® and Flector ®.
- Naproxen: for example Momendol ®, Synflex ® and Xenar ®.
- For topical use: they are mainly ointments or gels. They have the advantage of acting locally and without excessively straining the stomach and liver; however they are not very effective. This is NOT the most suitable pharmacological category and persisting for a long time with their use could favor the worsening of the inflammation.
- Ibuprofen 10% lysine salt or 2.5% Ketoprofen (for example Dolorfast ®, Lasonil ®, Fastum gel ® etc.).
- Corticosteroids:
- Injectable or orally: they are used only if oral NSAIDs are not well tolerated for: allergy, gastric ulcer, diabetes, etc. Using injectable ones for long periods can result in many side effects on connective tissues, especially tendons. On the other hand, they represent the most drastic and effective pharmacological solution.
Prevention
The prevention of pain localized in the shoulder mainly concerns the discomforts related to tendon inflammation.
- In this case, the first rule is undoubtedly to pay close attention to the movements to be performed:
- An accurate warm-up is essential before sporting gestures.
- Check the movements in maximum articular range.
- Do not overload the shoulder in unnatural postures.
- For athletes it is essential to take care of physical preparation also in terms of elasticity and mobility (stretching, etc.).
- In case of postural defects it is necessary to correct them; for example, dorsal hyperkyphosis can cause or aggravate inflammation of the rotator cuff.
- In the presence of painful symptoms or symptoms attributable to joint instability, contact your doctor.
- If the diagnosis is positive, take action to:
- Optimize muscle trophism.
- Gain the stability of the joint cuff.
- Improve the integrity of the tendons.
- If necessary, remove the tendon calcifications or bone spurs surgically or with medical treatment.
- Avoid creating imbalances between tendon resistance and muscle strength (as occurs with the use of anabolic steroids in sports).
- Review manual tools and aids in work, hobbies and sports, both in terms of ergonomics and weight.
Medical Treatments
- Tecar therapy: is a therapeutic method that uses an electric capacitor to treat joint muscle injuries and tendinopathies. The mechanism of tecar therapy is based on the restoration of the electrical charge in the injured cells, to make them regenerate more quickly.
- Laser therapy: it is a treatment that uses electromagnetic rays directly on the affected area. The electron beam from the laser acts on the cell membrane and mitochondria, increasing metabolic activity, reducing pain and inflammation, creating vasodilation and increasing lymphatic drainage.
- Ultrasound: this system uses high frequency acoustic waves. It is very useful as an anti-inflammatory, stimulant of edematous reabsorption and to dissolve the adhesions that form during healing. It produces heat and increases the permeability of cell membranes.
- Shock waves (Extracorporeal Shock Wave Terapy): crumble the tendon calcifications of modest entity. They are based on the localized release of acoustic impulses.
- Kinesio taping: Not very effective for the rotator cuff. It can be used in milder forms. Take advantage of the traction of adhesive and elastic bandages, which sometimes contain small pharmacological concentrations of anti-inflammatories, applied to the skin. They should have a draining, slightly pain-relieving-anti-inflammatory and bracing function.
- Surgery: It is essential for the repair of a total rupture of the injured tendons and sometimes for the removal of calcifications (see shoulder arthroscopy).
- Physiotherapy, strengthening stretching: useful in conservative therapy and both before and after surgery. They improve muscle strength, prevent / treat stiffness and optimize functional recovery.
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