Originally published in the British Horn Society Magazine February 2023.
For this edition I’d like to focus on shoulder pain. In particular a group of muscles known as the rotator cuff. It’s a common presentation that I see in clinic but it is also a common shoulder issue among musicians.
The rotator cuff is a group of muscles and tendons that surround and support the shoulder joint. These muscles and tendons work together to provide stability and strength to the shoulder, allowing for a wide range of motion. However, with overuse, injury or degenerative changes, the rotator cuff can become damaged, resulting in a rotator cuff injury.
As I said, rotator cuff injuries are common, particularly among musicians and also those who engage in activities that involve repetitive motion, holding a sustained weight (ie the horn) and activities such as throwing a ball or painting a ceiling. They can also occur as a result of a fall or other trauma (like a sudden awkward movement).
Symptoms
Symptoms of a rotator cuff injury include pain and weakness in the shoulder, particularly when lifting the arm sideways. The pain can be over the shoulder joint or down the arm. With severe injury some people may also experience a clicking or popping sensation in the shoulder, as well as stiffness and limited range of motion.
There are several different types of rotator cuff injuries, including:
Tendonitis: An inflammation of any of the tendons of the rotator cuff. This could be due to overuse, impingement or degenerative changes.
Bursitis: When a tendon becomes inflamed it can put extra pressure on the bursa which sit under a tendon to protect the bone. This causes swelling and pain knows as bursitis.
Tear: In severe cases it is possible to tear a muscle and/or tendon. There are different grades of tear from micro tears, partial thickness tears through to full thickness tears.
Treatment
Treatment for a rotator cuff problem depends on the severity of the injury and the individual's symptoms. Mild cases may be treated with rest, ice, and anti-inflammatory medication, as well as Osteopathy to strengthen the shoulder and improve range of motion.
Sometimes an injection into the shoulder can help reduce inflammation and pain. More severe cases may require surgery to repair the damaged tendons or muscles. Surgery may be performed using either open or arthroscopic techniques, and may involve reattaching the torn tendon to the bone or removing damaged tissue.
It's important to seek help if you suspect you may have a rotator cuff injury, as untreated injuries can lead to chronic pain and weakness in the shoulder, as well as a decreased range of motion.
Prevention
Preventing a rotator cuff injury involves taking steps to reduce the risk of overuse and injury. This includes:
Proper technique so that overload the shoulder become less likely.
A good warm up to make sure the shoulders are ready for activity.
Strength and flexibility exercise to keep the shoulders healthy.
Rest and recovery if you have pain.
Supportive aids. If you have a long standing issue with the shoulder then using an aid such as a strap, duck’s foot or support stick on the horn could be a way of reducing load through the shoulders.
In conclusion, a rotator cuff injury can be a painful and debilitating condition, but with prompt diagnosis and appropriate treatment, many people are able to recover and return to their normal activities. Taking steps to prevent injury through proper technique, warm-up, strengthening, and rest can help reduce the risk of a rotator cuff injury and ensure long-term shoulder health.
Happy playing!