As we age, our bodies are prone to minor ailments. Middle age often brings stiffness to many joints, making lifting heavy objects increasingly challenging, with arms and shoulders feeling unyielding and sometimes painful. For those who work or study at desks for extended periods, shoulder soreness is not uncommon. Many people assume they have rotator cuff tendinitis when their shoulders hurt, but is pain always indicative of this condition? And can simply moving more alleviate the discomfort? Let’s delve deeper.
What is Rotator Cuff Tendinitis?
Rotator cuff tendinitis, or inflammation around the shoulder joint, is a general term for any inflammatory disease affecting the tissues surrounding the shoulder joint. Commonly referred to as “frozen shoulder” or “shoulder impingement,” it typically occurs in middle-aged and older individuals, around the ages of fifty or sixty, causing pain, stiffness, and adhesion in the shoulder joint. The affected shoulder feels as if it’s frozen, hence the medical term “frozen shoulder.”
When the function of the shoulder joint is severely limited, patients find it impossible to lift their arms, turn over in bed, or perform routine household chores. Even slight movements can trigger intense pain due to the adhesion in the shoulder joint, leaving one feeling almost completely disabled.
What Causes Frozen Shoulder?
The most significant characteristic of a frozen shoulder is the limitation of both active and passive movements. This means that not only can the patient not lift their arm on their own, but others cannot help them either, due to severe contracture and adhesion of the soft tissues around the shoulder joint.
Several factors contribute to this condition:
Age is a primary factor, with a higher incidence among those around fifty or sixty years old. Younger individuals with shoulder pain are less likely to have frozen shoulder; their pain is usually caused by cervical spine issues from desk work or aseptic inflammation of muscles and soft tissues around the shoulder joint, as well as injuries to the rotator cuff tendons from physical activity.
Chronic pain in the shoulder joint leads to a gradual reduction in movement, which over time results in a decline in the joint’s mobility and subsequent contracture of the surrounding soft tissues.
Underlying chronic diseases, particularly diabetes, tumors, and uremia, can cause vascular changes in the surrounding tissues, leading to ischemia and contracture of the shoulder tissues. This scenario differs from the previous ones and often presents as acute stiffness in the shoulder joint, meaning the joint suddenly becomes immobile. Acute shoulder stiffness should be taken seriously.
Is Shoulder Pain Necessarily Rotator Cuff Tendinitis?
In reality, rotator cuff tendinitis is a broad and imprecise concept. In the past, due to limited understanding of shoulder disorders, all shoulder pain was often attributed to rotator cuff tendinitis. However, recent years have seen significant advancements in our understanding of shoulder conditions, particularly the causes of shoulder pain, rendering rotator cuff tendinitis an outdated term in the medical field.
There are many causes of shoulder pain, and rotator cuff tendinitis is not always the culprit. One important cause is injury to the rotator cuff tendons. Our humeral head is encased by a group of tendons forming a sleeve, known as the rotator cuff, consisting of the supraspinatus, infraspinatus, subscapularis, and teres minor tendons. The flexibility of the shoulder joint in various directions is closely linked to the pulling action of these tendons.
Injuries to the rotator cuff tendons from various causes, such as tears from violence or wear and tear from chronic use leading to friction, impact, tearing, and calcification, can impair the tendons’ normal function, resulting in shoulder pain and limited movement.
One such condition is subacromial impingement syndrome. We can feel a bony protrusion above the scapula and lateral to the clavicle called the acromion. The rotator cuff tendons run through the space beneath the acromion. If the shape of the acromion is hook-like, as we raise our arm outward, the tendons may strike against the “hook” below the acromion. This repetitive impact can lead to damage, degeneration, and even rupture of the rotator cuff tendons, which is a significant cause of rotator cuff injuries.
Should You Move More When Your Shoulder Hurts?
Pain in the shoulder joint should not be addressed with blind exercise. It is crucial to identify the underlying cause. Excessive movement could exacerbate a rotator cuff injury causing shoulder pain. If shoulder pain stems from chronic pain leading to reduced mobility, functional exercises can help prevent further contracture of the surrounding soft tissues, such as “wall climbing” or “beckoning cat” movements.
In daily life, maintain good posture and avoid prolonged periods of leaning forward. Diabetics should monitor and control their blood sugar levels. If you notice restricted shoulder movement, seek medical attention promptly to prevent further injury and adhesion of the tendons and soft tissues.