What is Rotator Cuff Tendonitis?

Rotator cuff tendonitis is inflammation of the rotator cuff tendons of the shoulder. The most common rotator cuff tendon to be inflamed is the supraspinatus tendon. This tendon is positioned on top of the shoulder between two bones: the acromion (which is a part of the shoulder blade or scapula) is above it and the humeral head (top of the arm bone) is below it. Athletes who participate in overhead activities, particularly swimmers, pitchers, and tennis players are more susceptible to developing rotator cuff tendonitis.

The rotator cuff is responsible for the movement of the shoulder along with the deltoid muscle. The rotator cuff is susceptible to wear and tear over time. Rotator cuff tendonitis is a condition in which the tendons become irritated and inflamed. This condition is also called subacromial impingement syndrome.

Chronic inflammation of a tendon leads to wear and tear and later degenerative changes in the microstructure of the tendon. This weakens the tendon over time, causing it to fray and ultimately tear. Dr. Cunningham is a shoulder specialist at Vail Summit Orthopedics and Nuerosurgery. He is an expert at diagnosing and treating rotator cuff tendonitis for patients in Vail, Summit County, Aspen, and Denver, CO.

What Causes Rotator Cuff Tendonitis?

Rotator cuff tendonitis is the least severe type of rotator cuff injury, but it can be very painful. Rotator cuff tendonitis is often a result of repetitive overhead activities. With overhead activities, the supraspinatus tendon can be pinched or impinged by the overlying acromion bone, leading to inflammation of the tendon. In young patients, rotator cuff tendonitis is often seen in those who participate in overhead sports such as swimming, volleyball and baseball. In older patients, rotator cuff tendonitis is often seen in those who have done physical overhead work such as construction or painting or who have done overhead sports for years.

What Does Rotator Cuff Tendonitis Feel Like?

Rotator cuff tendonitis often begins with mild pain and discomfort and may respond, initially, to rest, which relieves the pain. However, over time, the pain and discomfort can increase and become more constant. Additional symptoms of rotator cuff tendonitis may include:

  • Pain, which is worse with overhead activity
  • Pain located along the side of the shoulder
  • Clicking or popping sound with shoulder motion
  • Night pain that may waken you from sleep
  • Pain with normal activities such as putting a coat on
  • Decreased strength
  • Quick onset of pain with no antecedent injury

Rotator Cuff Tendonitis and Shoulder Impingement

Rotator cuff tendonitis is synonymous with shoulder subacromial impingement. Subacromial impingement occurs when the space between the rotator cuff tendons and overlying bony arch of the scapula (the acromion) contact one another, thus abrading and inflaming the tendon.  This contact is made worse when doing an overhead activity.

In older patients, impingement is more likely as there are often bone spurs which grow off the front of the acromion as a result of chronic inflammation in the area, leading to further pinching and irritation of the underlying tendons. Orthopedic attention is recommended for the diagnosis and treatment of rotator cuff tendonitis.

How to Diagnose and Treat Rotator Cuff Tendonitis?

Initially, a thorough history and physical exam should be performed by your orthopedist. Various areas about the shoulder are palpated to determine where one is tender and which structure is causing the pain. Shoulder range of motion is assessed to rule out a frozen shoulder. Rotator cuff strength testing is performed to try to rule out a rotator cuff tendon tear. Provocative physical exam tests are done to try to reproduce the symptoms of impingement to determine if that is the source of pain. Xrays may be ordered to determine if there is any shoulder arthritis or any other findings such as bone spurs causing impingement. A magnetic resonance imaging (MRI) of the shoulder may also be ordered if there is a concern for a rotatort cuff tear and not just rotator cuff tendonitis.

Rotator cuff tendonitis is initially treated with a nonsurgical approach. Treatment includes:

  • Restricting overhead activities that cause shoulder pain
  • Ice therapy
  • Pain management including an anti-inflammatory medication
  • An exercise program to maintain flexibility and prevent a frozen shoulder
  • Physical Therapy
  • A Steroid injection placed in the subacromial space (just above the inflamed tendons) if indicated

Rotator cuff tendonitis may take several months to heal. In cases where rotator cuff tendonitis does not respond to nonsurgical management, an MRI should be ordered to rule out a rotator cuff tear. A small percentage of rotator cuff tendonitis cases will come to surgical treatment.

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Does Rotator Cuff Tendonitis Require Surgery?

Non-surgical treatment does not always restore normal rotator cuff health. Some patients have a severely down sloping acromion or bone spur that continues to cause chronic tendon impingement. If these patients fail to respond to nonsurgical management, then arthroscopic shoulder surgery may be recommended. In this surgery, these impinging bone spurs will be removed arthroscopically using a high speed burr in order to eliminate this source of tendon impingement and prevent eventual tearing of the tendon. After this surgery, patients are placed in a sling for comfort, but they can come out of the sling immediately to start active range of motion exercises and later do rotator cuff strengthening exercises. Following this surgical procedure, most patients are back to a activities such as hiking or skiing in 6 weeks, but it may take 3 months to resume overhead sports like tennis. Dr. Cunningham is a shoulder specialist at Vail Summit Orthopedics and Neurosurgery. He is an expert at diagnosing and treating rotator cuff tendonitis for patients in Vail, Summit County, Aspen, and Denver, CO.

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