What is Rotator Cuff Tendinitis?
Rotator cuff tendinitis is the inflammation of the tendons that attach the shoulder muscles from the shoulder blades into the humerus, or upper arm bone. This muscle-tendon complex is made up of four muscles: the supraspinatus, infraspinatus, teres minor and subscapularis muscles.
To make it easier to recall this muscle group, the pneumonic S.I.T.S. is commonly used.
The four muscles comprising the rotator cuff connect to the shoulder, merging and forming a thick cuff over the joint. These muscles securely stabilize the head of the humerus into a cavity in the shoulder blade, allowing the shoulder joint to move in a great range of motion, which includes rotary movements.
According to research, rotator cuff tendinitis commonly occurs in individuals over the age of 40. This condition is also frequently reported in individuals who participate in sports or exercise regimens that mainly involve repetitive overhead arm motions.
Causes
Inflammation of the rotator cuff frequently results from shoulder overuse or overload. During excessive and repetitive overhead positions, a great strain is placed on the rotator cuff.
Thus, rotator cuff tendinitis is commonly seen in athletes, like swimmers, tennis and baseball players, who are involved in sports that require frequent overhead motions of the arms. This condition is also seen laborers, who are exposed to excessive lifting, pulling and pushing motions, lying on the affected side and overhead activities at work.
Rotator cuff tendinitis is also obtained from acute trauma where the muscles involved are placed on a great force or load that they cannot normally withstand. Shoulder pain after falling on your arm is likely an indication of tendinitis.
This condition is commonly seen in individuals between the ages of 40 and 50, suggesting that degeneration of the shoulder muscles increases the risk for tendinitis. With aging, calcium crystals are also deposited in these muscles, which result in inflammation of the tendons.
Additionally, rotator cuff tendinitis usually co-exists with bursitis or the inflammation of the bursa sac. Bursitis is also caused by overuse of the shoulder joints and by underlying medications, such as arthritis.
Signs and Symptoms
Shoulder pain is the most common complaint of individuals with rotator cuff tendinitis. The pain worsens with arm movements, most especially those involve in overhead motions and reaching behind the back.
The pain commonly occurs at night as the individual lies down on the affected side. Weakness of the affected shoulder joint and arm occurs with overhead normal activities, such as combing of hair and reaching over for objects on a shelf. Because of the pain and weakness, there is an inclination to keep the affected shoulder inactive.
Diagnosis
Individuals usually consult their physicians complaining of pain in the shoulder area. To determine its cause, a thorough physical examination is done and a detailed medical history is obtained.
The description, duration, severity and frequency of the pain are likely to be the focus in the history. Aggravating and alleviating factors relating to shoulder pain is usually noted.
An X-ray examination is frequently indicated to determine the exact cause of the shoulder pain and to rule out any underlying medical condition. Additional imaging examinations, such as magnetic resonance imaging, arthrography and ultrasonography, and screening tests might be necessary if an underlying condition is suspected.
Treatment
Rotator cuff tendinitis is initially treated with conservative techniques at home. During the first 72 hours after the trauma or on the initial stage of the inflammation, the Rest, Ice, Compression and Elevation, or R.I.C.E. regimen, is usually prescribed.
Since rotator cuff tendinitis is frequently caused by repetitive stress, the physician would normally recommend to rest the affected shoulder joint through a sling until it is pain-free and to avoid any movement that could cause or increase the pain.
An ice application for 15 to 20 minutes, at least thrice a day, for the first 48 hours is beneficial in alleviating the pain and the swelling.
Compression is done by wrapping a large Ace bandage around the affected area and across the body. The arm is also kept elevated, and it is advised to sleep on the unaffected side.
The R.I.C.E. regimen mainly reduces the inflammatory responses, which include swelling and pain. Oral non-steroidal anti-inflammatory medications are prescribed to relieve the pain.
After the pain and swelling have subsided, it is recommended to perform exercises that strengthen the rotator cuff muscles and stabilize the scapula. Simple exercises that regain shoulder flexibility and posture corrective exercises are also included in the program.
Regular physical therapy sessions might be necessary to prevent the recurrence of pain and to guide you in your gradual return to your daily activities.
If the signs and symptoms are still observed, in spite of constant adherence to the treatment regimen, your physician might recommend cortisone or steroid injections to reduce the inflammation. In some cases, a surgery might be indicated by your physician.
