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.

• Disability

  When two treatments are compared, it may be concluded that intra-articular steroid injection was more effective especially in the first weeks regarding pain, ROM and disability. [ncbi.nlm.nih.gov]

  The Shoulder Pain and Disability Index and the Oxford Analgesic Chart will be given before each treatment by the blinded research assistant. [isrctn.com]

• Pertussis

  Manufacturers CDC Information Package Inserts Email News Services PowerPoint Slides MORE VACCINES Anthrax Influenza PCV Smallpox Diphtheria Measles PPSV Tetanus Hepatitis A MenACWY Polio Varicella Hepatitis B MenB Rabies Zoster Hib Mumps Rotavirus HPV Pertussis [immunize.org]

• Frozen Shoulder

  Thermography can be helpful in the diagnosis of frozen shoulder but further studies are required to determine whether it is useful in other soft tissue shoulder lesions. [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]

  Soft tissue lesions of the shoulder Summary Definition Etiology Clinical features Subacromial impingement syndrome Frozen shoulder (adhesive capsulitis) Calcifying tendonitis Biceps tendinitis Diagnostics Clinical examination Instrumental diagnostics [amboss.com]

• Back Pain

  Pain Inside Pain: Arthritis Back Pain Headache Joint Replacement Other Pain Featured Content: Doctors’ pain pill prescribing habits at odds with current guidelines » Oh, my aching jaw » Don’t take back pain sitting down » Giving steroid injections a shot [health.harvard.edu]

  Signs & Symptoms Treatments Signs and symptoms of an Rotator Cuff Tendonitis may include: Pain with shoulder movement, most notably with reaching overhead or behind back Pain may radiate down the arm or into shoulder blade Mild to moderate pain typically [tria.com]

  There also may be underlying issues in the cervical and thoracic spine (neck and upper back), which need to be identified and corrected. [ssrehab.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]

  This type of shoulder pain is more common if you’re over 30. If not treated, it can lead to stiffness or weakness in your shoulder. Most of the time, it’s easily treated. [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]

• Muscle Weakness

  As the pain dissipates, strengthening exercises should be initiated to prevent muscle weakness and atrophy. [redefinehealthcare.com]

  Because many shoulder issues share similar symptoms (among them, muscle weakness, fractures, frozen shoulder, shoulder impingement, torn rotator cuffs, and SLAP lesion tears), it’s important to see an orthopedist or physical therapist for proper testing [coastalorthoteam.com]

  […] or excessive training inadequate warm up muscle weakness (especially the rotator cuff and scapula stabilisers) muscle imbalances inadequate rehabilitation following a previous shoulder injury or surgery inappropriate technique (e.g. swimming stroke, [physioadvisor.com.au]

• Low Back Pain

  Back Pain With a Multimodal Nonpharmacological Pain Relief Kit Journal of Performance Health Research | © 2018 Performance Health A pain relief kit, made… [ssrehab.com]

  Abstract Background: Shoulder pain is one of the leading causes of musculoskeletal disorders after low back pain and cervical pain, and rotator cuff tendinitis contributes to most common cause of the shoulder pain in person aged 70 years or older. [bibliomed.org]

  Local corticosteroid injections for low back pain and sciatica. Joint Bone Spine. 2008 May 15. [Medline]. Cole BJ, Schumacher HR Jr. Injectable corticosteroids in modern practice. J Am Acad Orthop Surg. 2005 Jan-Feb. 13(1):37-46. [Medline]. [medscape.com]

  The role of experimentally-induced subacromial pain on shoulder strength and throwing accuracy. Manual therapy. 2012;17(5):411-5. Epub 2012/04/17. 33. O'Sullivan P. It's time for change with the management of non-specific chronic low back pain. [fysioterapeuten.no]

• Fear

  For younger people, sports injuries are the main source of trouble, but the rest of us have more to fear from the normal wear and tear that, over time, weakens shoulder tissues and leaves them vulnerable to injury. [health.harvard.edu]

  By JEN GUNTER Photo Credit iStock Doctors Treating a Patient With a Nightmarish Condition She had lost all of her skin and I feared I had helped make her last weeks an unrelenting horror show, until our chance reunion. By ALESSANDRA COLAIANNI, M.D. [nytimes.com]

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].

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]

TREATMENT – SURGERY If conservative treatments are unable to correct the problem, surgery may be required. [sportsmed.com.au]

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]

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]

Shoulder Bursitis Long Head of Biceps Tendinitis Shoulder Instability Calcification of the Rotator Cuff Tendon Common Treatment Options Physiotherapy Prognosis for rotator cuff tendinitis is good in physiotherapy. [physiovive.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]

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 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]

Trauma, repetitive abnormal motions of scapula and iatrogenic causes take place in etiology. Injury of the nerve due to traction and elongation is the most probable pathomechanism. [go.gale.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]

"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]

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

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]

(Cover skin with a towel to prevent frostbite if you use a bag.) As the pain subsides, apply ice three times a day until you're completely pain-free. [prevention.com]

1. Bass E. Tendinopathy: Why the Difference Between Tendinitis and Tendinosis Matters. Int J Ther Massage Bodywork. 2012;5(1):14–17.
2. Andres BM, Murrell GAC. Treatment of Tendinopathy: What Works, What Does Not, and What is on the Horizon. Clin Orthop Relat Res. 2008;466(7):1539-1554. doi:10.1007/s11999-008-0260-1.
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.
4. Blackburn TA, White B, McLeod WD, Wofford L. EMG analysis of posterior rotator cuff exercises. Athl Training. 1990. 25:40-5.
5. Malanga GA, Bowen JE, Nadler SF, Lee A. Nonoperative management of shoulder injuries. J Back Musculoskeletal Rehab. 1999. 12:179-89.
6. Teefey SA, Hasan SA, Middleton WD, Patel M, Wright RW, Yamaguchi K. Ultrasonography of the rotator cuff. A comparison of ultrasonographic and arthroscopic findings in one hundred consecutive cases. J Bone Joint Surg Am. 2000 Apr. 82(4):498-504.
7. Read JW, Perko M. Shoulder ultrasound: diagnostic accuracy for impingement syndrome, rotator cuff tear, and biceps tendon pathology. J Shoulder Elbow Surg. 1998;7(3):264–271.
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.
9. Teefey SA, Middleton WD, Yamaguchi K. Shoulder sonography. State of the art. Radiol Clin North Am. 1999;37(4):767–785.