What is it?
Rotator cuff injuries are some of the most common shoulder injury. The rotator cuff is comprised of four muscles: subscapularis, suprasinatus, infraspinatus, and teres minor. These four muscles are responsible for stabilizing the shoulder girdle throughout the shoulders range of motion. Pain or weakness in curtain range of motion can determine which muscles are hurt. Subscapularis creates internal rotation. Supraspinatus creates abduction. External rotation is created by both infraspinatus and teres minor. Common injuries are rotator cuff tendonitis, rotator cuff impingement syndrome and a rotator cuff tear. This blog will focus on rotator cuff tendonitis.
What causes it?
Rotator cuff tendonitis is an overuse injury due to poor shoulder mechanics. To learn more about shoulder mechanic, please read through our blog “Shoulder Mechanics”. Rotator cuff tendinitis affects the tendons of the 4 muscles stabilizing muscles. Tendinitis means that these tendons are inflamed or irritated. Tendinitis of the rotator cuff can be caused from keeping the shoulder in one position over a period of time, sleeping on the shoulder every night, or participating in activities that require extending the arm over the head. Sometimes rotator cuff tendinitis can occur without any known cause. Most individuals with rotator cuff tendinitis are able to regain full function of the shoulder without any pain.
What are symptoms and how do you diagnosis it?
Symptoms of rotator cuff tendinitis tend to worsen over time. Initial symptoms may be relieved with rest, but eventually the symptoms can become constant. Symptoms of rotator cuff tendinitis include:
· pain and swelling in the front of the shoulder and side of the arm
· pain triggered by raising or lowering the arm
· clicking sound when raising the arm
· pain that causes you to wake from sleep
· pain when reaching behind the back
· loss of mobility and strength in the affected arm
Through the physical examination, including history and special tests, the treating provider can determine if the patient is suffering from rotator cuff tendonitis. The exam may include movement of the arm, shoulder and neck to test mobility and strength.
Your provider may order imaging tests to confirm the diagnosis of rotator cuff tendinitis and rule out any other causes of your symptoms. An X-ray may be ordered to see if you have a bone spur. Your provider may order an ultrasound or magnetic resonance imaging (MRI) to check for inflammation in the rotator cuff and to check for any tearing.
How do we treat it?
Conservative treatment is always the first line of defense. Shoulder strengthening, corrective exercises, postural changes, proper stretching and soft tissue work can be used in conservative treatment. Severe cases way require the use of a sling to prevent excessive use of the shoulder during the healing process.
If the rotator cuff tendinitis is not responding to conservative treatment, your provider may recommend a steroid injection. This is injected into the tendon to reduce inflammation, which reduces pain. This approach is used as a band-aid to the problem not a long term fix.
If nonsurgical treatment is not successful, your provider may recommend surgery. The most non-invasive form of shoulder surgery is accomplished by arthroscopy. This involves two or three small cuts around the shoulder, through which your doctor will insert various instruments. One of these instruments will have a camera, so your surgeon can view the damaged tissue through the small incisions.
Open shoulder surgery is usually not required for rotator cuff tendinitis. However, this method may be used if there are other problems in the shoulder, such as a large tendon tear. Any type of surgery involves recovery that consists of rest and physical therapy to restore strength and range of motion.