Rotator Cuff Tendinitis?
Shoulder pain is one of the most common physical complaints. You often hear the term "rotator cuff" when discussing shoulder injuries. What exactly is the rotator cuff? It's actually made up of four muscles: supraspinatus, infraspinatus, subscapularis and teres minor. Working together, they keep the head of the humerus (arm bone) in place in the scapula (shoulder blade) at what we call the "shoulder joint," and they allow the shoulder to move (rotate) in nearly any direction.
Damage to any one of the four muscles or their tendons can occur from acute injury, chronic overuse or gradual aging:
Acute rotator cuff tear
- This injury can develop from sudden powerful raising of the arm against resistance or in an attempt to cushion a fall (for example, heavy lifting or a fall on the shoulder).
- The injury requires a significant amount of force if person is younger than 30 years of age.
- Found among people in occupations or sports requiring excessive overhead activity (examples, painters, baseball pitchers)
- The chronic injuries may be a result of a previous acute injury that has caused a structural problem within the shoulder and affected the rotator cuff anatomy or function (for example, bone spurs that impinge upon a muscle or tendon causing inflammation).
- Repetitive trauma to the muscle by everyday movement of the shoulder
- Degeneration (wearing out) of the muscles with age
- This usually occurs where the tendon attaches to bone. The area has poor blood supply and a mild injury may take a long time to heal and potentially lead to a secondary tear.
Impingement Syndrome or "painful arc" syndrome is associated with rotator cuff tendonitis, specifically of the supraspinatus tendon. This tendon runs from the top of the scapula, under the acromion process and attaches at the top of the humerus. The acromion is the small protruding bone on the top surface of your shoulder. When this tendon becomes inflamed, it rubs against the acromion and creates tendonitis. While range of motion may stay the same, there is a definite arc, usually starting before 90º and ending around 160º, where lifting your arm to the side is painful.
Symptoms of rotator cuff injury can include: an acute, sharp pain during an activity involving the shoulder, such as throwing; a gradual weakness or decrease in arm abduction (to the side) range of motion; deep ache or pain in the outside of the arm (deltoid); increased pain when sleeping; increased pain with abduction or internal rotation of the shoulder. While acute injuries tend to occur in younger people and athletes, tendonitis occurs most often in people over the age of 40.
Physical therapy treatment is very effective for most rotator cuff/impingement injuries. Your doctor might also recommend anti-inflammatory drugs (NSAIDs). In some cases, where the tendon has become torn, or a bone spur has occurred on the acromion, orthroscopic surgery may be necessary. Your therapist will give you exercises to strengthen the weak muscles (which will reduce the strain on the inflamed tendon) and teach you proper techniques to avoid re-injury.