Rotator Cuff Tendonitis

 Rotator cuff tendonitis is a condition characterised by damage, inflammation and degeneration of one or more of the rotator cuff tendons.

 The rotator cuff is a group of four muscles which start off from the shoulder blade and fasten to the upper arm bone via the rotator cuff tendons. Jointly, the rotator cuff act to offer stability to the shoulder joint and aids with elevation and rotation movements of the shoulder.

These muscles and their tendons work together with other shoulder muscles to provide movement and strength to the shoulder for all waist-level and shoulder-level or above activities. 

Although this condition can occur at any age, it is commonly seen in patients between the ages of 40 and 60. 

Causes / Risk Factors

Throughout contraction of the rotator cuff muscles, tension is placed through the rotator cuff muscles and tendons. When this tension is extreme due to too much repetition or high force, damage to the rotator cuff tendons may occur.

This damage results in successive inflammation and deterioration to one or more of the rotator cuff tendons. 

The prolonged or repetitive activities that places strain on the rotator cuff include throwing, raking, washing cars or windows, excessive lifting, overhead activities, lying on the affected side, pushing, pulling and many other types of highly repetitive motions.

It may also occur as a result of an injury to the rotator cuff muscles. Rotator cuff injuries are the most frequent cause of shoulder pain and restriction of activities in sports.  

Sometimes, the condition may occur abruptly due to a high force going through the rotator cuff tendons beyond what they can withstand such as heavy or awkward lifting, a falling on an outstretched hand, heavy pushing or pulling, or a forceful throw. Rotator cuff tendonitis may also arise subsequent to a rotator cuff tear.

Rotator cuff tendonitis may occur in athletes involved in throwing sports such as baseball, swimming, and racquet sports such as tennis or weight lifting.

Other risk factors include:

• muscle tightness

• inadequate warm-up

• previous shoulder injury

• extreme or improper training or activity

• poor posture

• shoulder instability

• muscle weakness 

Symptoms

The symptoms of Rotator cuff Tendonitis generally develop gradually over a period of time. Frequently, the pain associated with this condition is felt as an ache in the shoulder that increases to a sharper pain or catching pain with certain activities.

The typical symptom includes a toothache-like pain radiating from the outer arm to the top of the shoulder and may hinder sleeping comfortably.

Symptoms are more often than not provoked by raising the arms overhead or reaching behind the body like retrieving an object from the back seat of a car. Sometimes, pain may also be experienced in the upper arm, shoulder blade, upper back or neck.

In individuals with minor Rotator cuff Tendonitis, little or no symptoms may be present. These individuals are usually able to maintain sport or activity only to have an increase in pain, ache or stiffness upon resting later. In severe or chronic conditions, the pain may be disabling, preventing further activity. 

Muscle wasting, weakness and night pain (regardless of position) may also be present. Individuals experience pain or difficulty when lifting heavy objects (especially overhead), elevating the affected arm, using the arm in front of the body, during heavy pushing or pulling or when lying on the affected side.

Individuals may also experience 'clicking', an occasional sensation of the shoulder feeling 'out of place’ or pins and needles, numbness or a 'dead arm'

Diagnosis of Rotator cuff Tendonitis

A thorough examination is necessary to diagnose Rotator cuff Tendonitis. The individual’s shoulder is examined to check whether there is pain. He /she may also move the arm in particular directions to test for the range of motion of the shoulder joint. The muscle strength is also examined as well as the neck to check for conditions that could cause symptoms similar to Rotator cuff Tendonitis.

Image tests may be ordered to confirm diagnosis and rule out other causes of the individual’s symptoms. An ultrasound, x-ray or MRI may be ordered to confirm diagnosis of Rotator Cuff Tendonitis and assess the severity of the condition.

To be continued…

The writer is a Senior Physiotherapist at the 37 military Hospital

panierusa@live.com