Have you been experiencing shoulder pain? It could be Rotator Cuff Related Shoulder Pain, also know as RCRSP.
Shoulder pain accounts for the third most complained site of musculoskeletal pain. As people get older, research has found that 1% of those over 45 years old have visited a health care provider with a new complaint of shoulder pain. So what may be contributing to this?
This can be attributed to Rotator Cuff Related Shoulder Pain (RCRSP) which accounts for 80% of shoulder pain seen by primary care practitioners. It is normally seen in people having on-going pain when they lift their shoulders up from the side, moving their arm like a baseball pitch, or any type of movement identical to arm wrestling. In this post, we’ll define the term RCRSP, elaborate what structures may be involved, and how to best manage it going forward and get you back and living life.
What is RCRSP?
Jeremy Lewis has developed the term Rotator Cuff Related Shoulder Pain (RCRSP) which encompasses a range of conditions of the shoulder such as symptomatic full thickness tears of the rotator cuffs, rotator cuff tendinopathy, and subacromial pain (impingement) syndrome.
The rotator cuff is made up of 4 key muscles named supraspinatus, infraspinatus, teres minor, and subscapularis. The key functions are made up of three muscles doing external rotation and one muscle doing internal rotation of the shoulder. This was already elaborated on by our very own Tahlia Hensley on her previous post of “rotator cuff tears” which I would recommend to read up on. To further emphasise what she had delved into, is that those four key muscles of the shoulder are constantly active in all movements of the shoulder. Having difficulties in the area regarding the muscle, the tendon, the bursa, or the subacromial space can result in RCRSP.
Additionally, the recent research has delved into pain in the region diagnosed with RCRSP being contributed by numerous factors such as genetics, hormonal influences, smoking, alcohol consumption, comorbidities, level of education, biomechanical, patho-anatomical, peripheral and central sensitisation, sensory-motor cortex changes, and psychological changes. Additionally, it is affected by improper loading of the tissues or excessive stress, greater than what the individual’s shoulder capacity might be.
Why is RCRSP Important?
Seeing a primary care practitioner such as a physiotherapist to assist with diagnosis and management of RCRSP can go a long way. The difficulties with shoulder pain is being able to rule out more sinister pathologies such as cancer, stroke, or other pathologies such a thoracic outlet syndrome. As different pathologies may also arise from the neck or back that contribute to shoulder pain.
There are also numerous interventions that can help treat RCRSP such as the following:
- Exercise therapy
- Manual therapy
- Injection therapy
- Acupuncture/dry needling
- Shockwave therapy
However, the key thing to note is that not all interventions will work for the individual and it must be tailored to the specific needs of the person presenting with RCRSP. It is also worth remembering that based on the literature, conservative management/exercises/gradual progression has showed to be equal or superior to surgery or injection therapy. Therefore, it is advised to perform at least 12 weeks of rehabilitation before attempting to go through surgery or injection therapy. You can further discuss with your health care practitioner.
# Tips and Reminders for RCRSP
See a health care practitioner if the following may arise:
- Pain around the shoulder region
- Pain when bringing your arms from the side and up to your ears
- Pain when moving your arm in or out, identical to arm wrestling
- Loss of shoulder function
- Decreased shoulder strength
It is also advised that when diagnosed with RCRSP, the best treatment management would be gradual progression of shoulder function and advice on modifying load and pathology. It is recommended to conservatively manage the shoulder for at least 12 weeks, giving it time to naturally adapt to the stimuli.
To summarise, RCRSP is an over-arching term that encompasses several key pathologies as discussed above. Current best line of management for this condition is to gradually progress function and tolerance of the shoulder girdle as guided by a health care professional.
If not attended to, it can lead to improper management of the shoulder and further delays of returning to full function and all the activities requiring the shoulder.
What to do now?
If you or a friend are suffering from Rotator Cuff tendinopathy give us a call at Gen Physio, we have a friendly team of professionals that are dedicated to changing the lives of our clients. All of our clinicians are mobile and come to your own home to conduct an examination. Give us a call on 1300 122 884 to book a consultation today.
Cook, T., & Lewis, J. (2019). Rotator Cuff-Related Shoulder Pain: To Inject or Not to Inject? The Journal of Orthopaedic and Sports Physical Therapy, 49(5), 289–293. https://doi.org/10.2519/jospt.2019.0607
Lewis, J. (2016). Rotator cuff related shoulder pain: Assessment, management and uncertainties. Manual Therapy, 23, 57–68. https://doi.org/10.1016/j.math.2016.03.009