Rotator cuff tendonitis


By Joseph M. Harris, PT, ATC, CEAS - President/Clinical Director - Physical Therapy Solutions, PSC



Harris


Rotator cuff tendonitis is a common cause of shoulder pain. It is caused by overuse of the shoulder or overloading of the shoulder muscles. Overusing the shoulder muscles occurs when a person does repetitive activities with the shoulder. This might occur as a result of sports activities, especially overhead sports such as volleyball, baseball, or swimming. Overuse may also occur as a result of work activities either at home or on the job. This happens particularly when new activities are started or there is an increase in the frequency of an activity. Patients may present after taking on a painting or remodeling project in their home. Overload of the rotator cuff tendon occurs when too much load is suddenly applied to the shoulder. This may happen during a fall or when there is a sudden jerk on the shoulder. A patient may present with pain when trying to catch a heavy falling object.

The rotator cuff is the name given to a group of four small muscles around the shoulder that have an attachment on the shoulder blade, the scapula, and the upper arm bone, the humerus. The four muscles that make up the rotator cuff are the supraspinatus, the infraspinatus, the teres minor, and the subscapularis. These muscles work together to properly move the arm through the shoulder socket. A tendon is the part of the muscle that attaches to the bone. Because of the location of the supraspinatus and its tendon, it is the most commonly injured of the four rotator cuff muscles.

When the rotator cuff becomes injured, the person may feel pain around the shoulder. Pain may be specifically in the front of the shoulder but typically occurs throughout the shoulder and may even be referred into the outside of the upper arm. Pain is often increased when the person raises their arm or when the person is resting in bed. While shoulder range of motion and strength may be decreased, this is not always the case. When treatment is not received, the condition often worsens.

Diagnosis is often made by examination by the medical practitioner and by thorough history of the problem. While x-rays do not show the rotator cuff tendons, they show bony structure that may give clues as to the diagnosis. MRI is often not ordered until the patient has tried and failed conservative treatment.

Treatment of rotator cuff tendonitis includes decreasing inflammation with the use of anti-inflammatory medications, ice, and rest. Treatment with physical therapy has been shown to be successful in resolving the problem in over 70 percent of cases. The physical therapist will use exercise, education, and modalities to help the patient decrease pain and inflammation and improve joint mechanics and posture. An injection into the shoulder may also be effective in reducing pain and inflammation to the tendon. Most patients demonstrate good relief of their symptoms after receiving treatment. Some may take a little longer. Most symptoms are resolved in a few weeks to a few months. If pain persists, the physician may investigate further for other causes of shoulder pain such as a tear of the rotator cuff.

Harris
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By Joseph M. Harris, PT, ATC, CEAS

President/Clinical Director

Physical Therapy Solutions, PSC

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