The etiology of rotator cuff tendinitis is still under debate. The intrinsic, extrinsic, and overuse mechanisms have been proposed as etiological factors.

The degeneration in rotator cuff tendinitis occurs in response to chronic overuse of the tendon without giving it time to rest and heal, disrupting the balance between protective and regenerative mechanisms and overuse pathologic changes. The end result is weakness, pain, and loss of shoulder motion [1] [2].

The symptoms of rotator cuff tendinitis can be acute, occur after an injury to the shoulder, or be associated with overuse. Symptoms are often insidious in elderly patients. The pain is usually felt as a dull ache on the anterolateral part of the shoulder and is aggravated by overhead activities. It is worse on shoulder abduction or flexion between 60° and 120° and is frequently minimal or absent outside of this range. Passive abduction causes less pain, however, abduction against resistance may aggravate the pain. Feeling pain during the night is common, especially if the patient lies on the affected side.

• Abdominal Obesity

  CONCLUSIONS: Our findings showed associations of abdominal obesity, some other metabolic factors and carotid intima-media thickness with shoulder pain. [ncbi.nlm.nih.gov]

  Conclusions Metabolic factors, especially abdominal obesity, and carotid intima-media thickness were associated with shoulder pain. Type 1 diabetes mellitus and abdominal obesity were associated with chronic rotator cuff tendinitis in men. [bmcmusculoskeletdisord.biomedcentral.com]

• Frozen Shoulder

  Differences in skin temperature distribution were found in 82% of subjects with frozen shoulder, nearly three-quarters of whom had reduced skin temperature. [ncbi.nlm.nih.gov]

  Frozen Shoulder (a true frozen shoulder is not that common. Rotator cuff tendinitis is often misdiagnosed as frozen shoulder.) [physiovive.com]

  The Niel Asher Technique for treating frozen shoulder was first introduced and published in 1997 and has been widely adopted by therapists and exercise professionals working within elite sports and athletics. [nielasher.com]

  During that time, a physical or occupational therapist will provide passive range of motion exercises to decrease likelihood of developing frozen shoulder while using the sling. [orthocenter-si.com]

• Stiffness of the Shoulder

  Patients may note some stiffness in the shoulder especially reaching behind their back. X-rays are typically normal and if an MRI is obtained it may show some mild fraying of the rotator cuff but no complete tear. [ortho.wustl.edu]

  Once your pain starts to go away, you can use a heating pad to lessen any stiffness in your shoulder. Stretching. Your doctor can give you daily exercises to do at home to get your shoulder more flexible. Doing these in a hot shower may help. [webmd.com]

  Some of these factors include: joint stiffness (particularly the shoulder, neck or upper back) shoulder instability bony anomalies of the acromion or AC joint muscle tightness (particularly the rotator cuff, pectorals and deltoid) poor posture inappropriate [physioadvisor.com.au]

• Left Shoulder Pain

  CASE: A 42-year-old professional woman experiencing emotional pain from a recent divorce presented with severe left shoulder pain, decreased range of motion, and paresthesias in the back of the neck and left arm. [anthromed.org]

  When to Contact a Medical Professional Sudden left shoulder pain can sometimes be a sign of a heart attack. [mountsinai.org]

• Myofascial Trigger Point

  More About Us NAMTPT AWARD 2017 We are honored to have received the 2017 " Excellence in Education " Award from the National Association of Myofascial Trigger Point Therapists. [nielasher.com]

  Treatment of myofascial trigger points in common shoulder disorders by physical therapy: a randomized controlled trial [ISRCTN75722066]. BMC Musculoskelet Disord 2007;8:107. 14. Goutallier D, Postel JM, Bernageau J, et al. [mafiadoc.com]

• Spine Stiffness

  stiffness / restriction cervical spine nerve pinching or adverse neural tension (lack of mobility / flexibility of nerve tissue supplying the shoulder area) weak shoulder blade area muscles (remember, the rotator cuff muscles come from here before going [phyzio.biz]

Obtaining a detailed history is essential for ruling out other diagnoses such as referred pain from cervical spine or serious symptoms of cardiac origin. Shoulder examination should be systematical. The shoulder must be exposed entirely. Inspection, palpation, motor strength, the range of movement (ROM), and special tests should be performed.

Tenderness is often localized to the greater tuberosity and subacromial bursa. Active and passive ROM in all planes has to be evaluated as part of the physical examination. Strength assessment can help isolating the relevant muscles.

Two techniques have been described in the literature to test the supraspinatus muscle:

1. Thumbs down position: elbow extended, shoulder in full internal rotation, the arm in the scapular plane [3].
2. Thumbs up position: test in the prone position, elbow extended, shoulder abduction to 100° with external rotation while the patient lifts in abduction [4].

Although both of these techniques activate the supraspinatus muscle, neither of them can truly isolate it since other muscles are also active during the evaluation [5]. Subtle weakness during either position can represent early degeneration in the rotator cuff.

• Neer impingement test: In this special examination, the shoulder is forcibly flexed forward and rotated internally, therefore the greater tuberosity will jam against the anterior inferior surface of the acromion. Pain during this test indicates a positive result which reveals an overuse injury to supraspinatus or biceps tendon.
• Hawkins-Kennedy impingement test: Another special type of assessment, in which the shoulder and elbow are flexed forward to 90° and the shoulder is forcibly rotated internally. Pain reflects a positive test and identifies greater tuberosity and supraspinatus tendon impingement under the coracoacromial ligament and the coracoid process.

Plain radiography of the shoulder in a true anteroposterior (AP) view, an axillary view, and supraspinatus outlet view is very helpful in the diagnosis of rotator cuff tendinitis. Magnetic resonance imaging (MRI) is extremely sensitive and specific while being non-invasive. It has the ability to detect the characteristics, size, and location of the pathology. Ultrasonography can also be employed to evaluate the rotator cuff muscles. it is less costly but as it is operator-dependent, the sensitivity and specificity of the results obtained may vary [6] [7] [8] [9].

• Cervical Spine X-Ray

  Cervical spine X-Rays showed osteoarthritis of the cervical spine with foraminal narrowing at C3-4 and, to a lesser degree, at C5-6 and C6-7. EMG changes of the cervical paraspinals were consistent with mild C4-5 radiculopathy. [anthromed.org]

CONCLUSION: There is no difference between the effect of additional acupuncture treatment and placebo TENS in the treatment of rotator cuff tendinitis. [ncbi.nlm.nih.gov]

Dominant arm involvement was associated with a poorer prognosis (p less than 0.05). Functional impairment occurred in 29 patients, two having lost employment. [ncbi.nlm.nih.gov]

(Outcomes/Resolutions) In the majority of the individuals, the long-term prognosis of Rotator Cuff Tendinitis is usually good. [dovemed.com]

Prognosis Most people recover full function following a course of conservative care that includes physical therapy, medication and/or injections. [twinboro.com]

Impingement is the most commonly diagnosed shoulder problem and likely has numerous potential mechanisms, which can impact both treatment and prognosis. FIGURE 156-1 Rotator cuff tear. [accessphysiotherapy.mhmedical.com]

Abstract A discussion of the etiologic and pathologic factors associated with rotator cuff tendinitis and rupture concludes that intrinsic muscle contractile tension overload rather than primary impingement is the major factor in the etiology of rotator [ncbi.nlm.nih.gov]

Etiology People over 40 are particularly susceptible because of decreased vascular supply to the rotator cuff tendons. Those who perform repeated overhead motions are also at risk. [medical-dictionary.thefreedictionary.com]

The etiology of rotator cuff tendinitis is still under debate. The intrinsic, extrinsic, and overuse mechanisms have been proposed as etiological factors. [symptoma.com]

Definition Narrowing of the subacromial and/or subcoracoid space with entrapment of soft tissue structures; especially involves the rotator cuff and subacromial bursa Etiology Overuse: activities involving repetitive overhead activity (e.g., basketball [amboss.com]

(Etiology) There are 4 main muscles that connect the upper arm bone (humerus) to the shoulder blade (scapula), which constitute the rotator cuff. [dovemed.com]

Dos pacientes com diagnóstico clínico de tendinite de supra-espinhal o nexo causal com o trabalho foi estabelecido em 100 pacientes (94,3%) Abstract: Epidemiological profile of pacients with supraspinatus tendinitis related to work in an outpatient Clinic [repositorio.unicamp.br]

University of Melbourne, Melbourne, Victoria, Australia Vaccine and Immunization Research Group, Murdoch Children's Research Institute and the Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia Clinical Epidemiology [eurekalert.org]

Review Article, 303 - 308 Epidemiology of the rotator cuff tears: a new incidence related to thyroid disease Oliva F., Osti L., Padulo J., Maffulli N. [mltj.online]

American journal of epidemiology. 2005, 161 (9): 847-855. 10.1093/aje/kwi112. [bmcmusculoskeletdisord.biomedcentral.com]

"Epidemiology of rotator cuff tendinopathy: a systematic review". Shoulder & Elbow. 5 (4): 256–265. doi : 10.1111/sae.12028. ISSN 1758-5740. "Inflammation". The Free Dictionary. "avascular". The Free Dictionary. Rees, J. [en.wikipedia.org]

In all probability, the intrinsic and the extrinsic theories coexist and explain the pathophysiology of rotator cuff degeneration. [emedicine.medscape.com]

The Pain of Tendinopathy: Physiological or Pathophysiological? Sports Med. 2013 Sep 12. [shouldercommunity.com]

[…] we have investigated the pathophysiological mechanisms leading to a chronic myofascial pain syndrome. Our goal is now to explain how we can assess and treat common myofascial shoulder pains. [tao-garden.com]

[ edit ] As of 2016 the pathophysiology is poorly understood; while inflammation appears to play a role, the relationships among changes to the structure of tissue, the function of tendons, and pain are not understood and there are several competing [en.wikipedia.org]

If possible, consider undertaking occupational therapy, or taking a class, to learn the best techniques to prevent rotator cuff strain. Equipment can also play a part in preventing bouts of rotator cuff tendinitis. [blog.drseeds.com]

How Is Rotator Cuff Tendinitis Prevented? Strengthening the rotator cuff muscles and complementary shoulder muscles, such as the rhomboids and trapezius, can help prevent injury. Do not play through pain. [luriechildrens.org]

Preventing Rotator Cuff Tendinitis Small measures can be taken by at-risk individuals to help prevent tendinitis. It is far easier to prevent the condition than it is to treat it, as some damage may be irreversible or costly to fix. [redefinehealthcare.com]

To help prevent this, follow instructions you are given for active rest and for doing exercises to help your shoulder heal. [uchealth.org]

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3. Jobe FW, Moynes DR. Delineation of diagnostic criteria and a rehabilitation program for rotator cuff injuries. Am J Sports Med. 1982 Nov-Dec. 10(6):336-9.
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8. Paavolainen P, Ahovuo J. Ultrasonography and arthrography in the diagnosis of tears of the rotator cuff. J Bone Joint Surg Am. 1994;76(3):335–340.
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