Edit concept Question Editor Create issue ticket

Rotator Cuff Tendinitis

Rotator Cuff Tendonitis

The most common cause of shoulder pain is rotator cuff injury and it compasses a spectrum of disorders ranging from acute reversible tendinitis to massive tears.


Presentation

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.

Italian
  • […] subacromiale , Schouder-'impingement'-syndroom , Subacromiale 'impingement' , Syndroom, schouder-'impingement'- German Engpass-Syndrome der Schulter , Impingement-Syndrom der Schulter , Schulter-Impingementsyndrom , Subakromiales Impingementsyndrom Italian[fpnotebook.com]
  • Impingement, subacromiale, Schouder-'impingement'-syndroom, Subacromiale 'impingement', Syndroom, schouder-'impingement'- German Engpass-Syndrome der Schulter, Impingement-Syndrom der Schulter, Schulter-Impingementsyndrom, Subakromiales Impingementsyndrom Italian[fpnotebook.com]
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]
Plethora
  • A great plethora of verbosity can be found here: Goal is to address the individual impairments to decrease pain, improve ROM, maximize strength, and optimize posture. 3,5,6 1.[morphopedics.wikidot.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]
  • OBJECTIVE: This review discusses the efficacy of local corticosteroid injections in the treatment of rotator cuff tendinitis (except for frozen shoulder and calcific tendinitis) according to the controlled studies published in the literature.[ncbi.nlm.nih.gov]
  • 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]
  • But doing so may lead to a condition called “frozen shoulder.” To help prevent this, following instructions you are given for active rest and for doing exercises to help your shoulder heal.[healthlibrary.brighamandwomens.org]
  • This condition is called Adhesive Capsulitis or frozen shoulder . Frozen shoulder is particularly common in women between the ages of 40 and 60. The risk factors that can lead to Adhesive Capsulitis include diabetes and thyroid disorders.[seacoastshoulder.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]
Left Shoulder Pain
  • When to Contact a Medical Professional Sudden left shoulder pain can sometimes be a sign of a heart attack.[mountsinai.org]
Foot Pain
  • Commodes and Accessories Grab Bars Shower Chairs Transfer Benches Walk In Tubs Braces Back Supports & Braces Cervical Neck Pain Comfort Cool Tennis Elbow Braces - Elbow Wraps, Sleeves & Bands Finger - Thumb Supports Foot and Ankle Braces - Supports Foot[activeforever.com]
Joint Tenderness
  • Limited range of motion in your shoulder's glenohumeral joint. Tenderness and a burning sensation in your shoulder.[aidmyrotatorcuff.com]
Distractibility
  • […] motions Retain Mobility PROM, AAROM, ROM in pain free range Joint Mobilization Techniques Inferior glides in scapular plane Anterior glides in scapular plane Posterior glides in scapular plane Codman’s pendulums – promote pain-inhibiting grade II joint distraction[morphopedics.wikidot.com]
Tingling
  • Numbness or tingling is usually not associated unless there is nerve irritation in the neck in conjunction with the shoulder pain. Patients may note some stiffness in the shoulder especially reaching behind their back.[ortho.wustl.edu]
Incontinence
  • Search: Home Bath Safety Braces Impotence & Male ED Incontinence Mobility Shop By Categories Shop by Topic Gift Ideas Respiratory Miscellaneous Home Bath Safety Bath Lifts Bathing Aids - Hygiene Bidet Toilet Seats Commodes and Accessories Grab Bars Shower[activeforever.com]

Workup

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].

Treatment

  • 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]
  • The aim of this study to compare the effect of intra-articular injection of corticosteroid and conventional transcutaneous electrical nerve stimulator (TENS) treatment in treatment of rotator cuff tendinitis.[ncbi.nlm.nih.gov]
  • Assessment of the treatment outcome was made by experienced orthopaedists not informed of the treatment allocation.[ncbi.nlm.nih.gov]
  • METHODS: A total of 40 potential study subjects, who complained of shoulder pain from a RCT, were enrolled and randomly assigned to standard rehabilitation treatment plus SSNB (Group A) or to standard rehabilitation treatment alone (Group B).[ncbi.nlm.nih.gov]
  • CONCLUSION: Local corticosteroid injections seem to be effective in the treatment of rotator cuff tendinitis. However, a controlled study more closely reflecting clinical practice is needed to confirm these data.[ncbi.nlm.nih.gov]

Prognosis

  • 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]
  • Also Read: Rotator Cuff Injury: Best Treatments and Recovery Note Rotator Cuff Tear: Types, Causes, Risk Factors, Symptoms, Diagnosis, Treatment, Recovery, Rehabilitation, Complications Rotator Cuff Impingement: Symptoms, Causes, Treatment, Prognosis[epainassist.com]

Etiology

  • 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]
  • 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]
  • (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]

Pathophysiology

  • In all probability, the intrinsic and the extrinsic theories coexist and explain the pathophysiology of rotator cuff degeneration.[emedicine.medscape.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]
  • The Pain of Tendinopathy: Physiological or Pathophysiological? Sports Med. 2013 Sep 12.[shouldercommunity.com]

Prevention

  • 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]
  • This video explains symptoms of this syndrome, possible treatments, and ways you can prevent shoulder injuries.[urmc.rochester.edu]
  • In order to prevent a recurrence as you return to your sport, your physiotherapist will guide you through exercises to address these important components of rehabilitation to both prevent a recurrence and improve your sporting performance.[physioworks.com.au]

References

Article

  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.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-07-11 20:41