April 18, 2012 Leave a comment
What is rotator cuff tendonitis, and what causes it?
The rotator cuff consists of four muscles: the supraspinatus, infraspinatus, the subscapularis, and the teres minor. The rotator cuff holds the proximal end of the humerus in place, forming a ball-and-socket joint. The four muscles help stabilize the joint and aid in the controlled movement of the shoulder throughout its range of motion.
Tendonitis can occur from overuse or traumatic injury; tendons can get irritated and tear, and bursitis (inflamed bursae) can arise. The most often rotator cuff muscle affected is the supraspinatus. This is because of where it sits between the humerus and the acromion process of the scapula – it’s such a tight canal that, when inflamed, impingement is common.
Rotator cuff impingement syndrome is often associated with keeping the arm in the same position over a long duration. Painters, hair stylists, side-sleepers, and those with forward posture are especially subject to overuse rotator cuff injury. Also, sports that require constant overhead shoulder stress, like swimmers, baseball players, and powerlifters, are at a greater risk of developing shoulder tendinopathy.
In impingement syndrome, pain occurs early on with overhead activities and abduction. Simple activities like putting on shirts, reaching for objects, and combing hair can all bring discomfort.
Pain from impingement, if it occurs, will often occur at the front of the shoulder, possibly radiating down the side of the upper arm. It is normal for the pain to stop before the elbow; however, in severe cases, the nerve may become pinched and pain can radiate past the elbow. If pain symptoms become more frequent, it is obviously a sign that the impingement is getting worse. Likewise with impingement, stiffness and limited range of motion is common.
Pain from tears is often more acute – in a complete tear, a snapping noise is often heard, and immediate pain is intense. Chronic and partial tears often get worse over time and lead to increasingly limited mobility and strength. Pain at night that increases in the morning is another sign of acute inflammatory response, and is probably a sign that you should see somebody.
Upon receiving a physical examination by your doctor or physical therapist, tenderness may be observed in the area over the shoulder. Pain may also be present during shoulder abduction and elevation. There is typically weakness of the shoulder observed when placed in certain positions especially during isometric contractions.
The following tests may be administered in order to better diagnose and treat your shoulder tendinopathy.
- Ultrasound tests use sound waves to create an image of the affected joint. It can often show if there is a tear in the rotator cuff.
- MRI is a similar image technique which uses electromagnetic waves to show if there is swelling or a tear in the rotator cuff.
- Arthrography is sometimes needed to diagnose a rotator cuff tear. In this test a doctor will inject contrast material into the affected shoulder joint. Then either use an x-ray, CT scan, or MRI scan to take an image of it. Contrast is most often used when your doctor suspects a small rotator cuff tear.
Treatment for shoulder tendonitis involves resting the shoulder and avoiding those activities that cause pain. Using the P.R.I.C.E method we can treat this tendinopathy.
- P-protect: in physical activity wearing a shoulder brace or added padding can reduce further aggravation to the joint injury
- R-rest: avoid strenuous activity that could further injure the joint, depending on the severity, for at least 72 hours. This is the most effective time to apply ice and reduce swelling. However while refraining from painful movements is important, complete immobilization may, in some cases, freeze joint capsules, and induce tightness, atrophy, and avascularity. These result in limited range of motion, weakness, and slower healing, respectively. Passive stretching and/or mobilization can be a good way to keep muscle active without further aggravating inflamed tissue.
- I-ice: ice packs should be applied 20 minutes at a time, 3 – 4 times a day to the shoulder.
- C-compression: ace bandages can be used to apply pressure to the affected area, aiding in joint stability and reducing swelling.
- E-Elevate: Draw swelling from the effected area using the forces of gravity to your advantage.
Besides PRICE other methods can aid in the treatment of shoulder tendonitis such as…
- Taking drugs like ibuprofen and naproxen to help reduce swelling and pain
- Performing eccentric exercises like the VIDEO BELOW
- Avoiding or reducing activities that cause or worsen your symptoms to worsen
With proper rest and exercise, symptoms often improve or go away. However, this may take weeks or months to occur.
While these treatment options are helpful it is important to always consult with a trained professional whether it be your doctor or physical therapist. They will determine the appropriate exercise treatment plan to strengthen the surrounding area of the rotator cuff while attempting to avoid further injury to the affected muscle.
Call for an appointment with your health care provider if persistent shoulder pain occurs. Also call if symptoms do not improve with treatment.
While it is hard to avoid these injuries, specifically in athletes, some ways in which you can minimize your risk of developing shoulder tendonitis include.
- Avoid repetitive overhead movements
- Develop shoulder strength in opposing muscle groups
- Stretch the shoulder in order to increase the range of motion
- Leaving muscles less subject to a tear-like injury
- Ice the rotator cuff area after a strenuous activity involving those muscles
References: 1. Ma, MD, C. B. (2010, July 21). Rotator cuff problems: MedlinePlus Medical Encyclopedia. National Library of Medicine – National Institutes of Health. Retrieved May 8, 2012, from http://www.nlm.nih.gov/medlineplus/ency/article/000438.htm
2. Simmons, Sierra. “Rotator Figure 1” Online Image. Injury Timeout. 2012. 24 Apr 2012. <http://injurytimeout.org/rotator_cuffs.html>
Here is an eccentric exercise that limits tendonitis in the rotator cuff muscles. Some call this “flossing the door.” It is eccentric, and the load for each shoulder is completely controlled by the opposing arm.