Shoulder Pain – Rotator Cuff Tendinitis / Tendinopathy

Shoulder musclesThe Rotator Cuff is a group of 4 small shoulder muscles (on top: supraspinatus; in the back: infraspinatus; in the back: teres minor; at the front: subscapularis). Their main role is to stabilize the shoulder joint, which by itself is very shallow, to allow us more range of movement in the shoulder. The body relies on the joint capsule, the rotator cuff muscles, and the surrounding muscles to keep the shoulder stable through its movement range.

Tendinitis is the inflammation of the tendon (the rotator cuff muscles turn into the tendon before attaching to the bone). There could be many causes to this inflammation (see below). When inflamed, the rotator cuff muscle’s job as a shoulder stabilizer will be impacted. The human body is really great at repairing itself. If your shoulder pain and rotator cuff tendinitis is not healing as it is supposed to, something is preventing it from healing, and re-aggravating the inflammation. A Physiotherapist can assess your movement and find out the reason behind the rotator cuff tendinitis.

Symptoms of Rotator Cuff Tendinitis

  • Pain in the shoulder area, usually limited to around the shoulder and upper arm.
  • Difficulty and pain with lifting the arm, putting arm behind the back, reaching backwards, etc.
  • Discomfort and pain with sleeping on the affected side.

Common Causes of Rotator Cuff Tendinitis

  • Trauma (i.e.: Falling on it, Catching yourself on landing, Hitting the shoulder, etc.)
  • Repetitive Injury ( i.e.: Throwing, lifting arm above head, etc.)
  • Impingement: Two of the rotator cuff muscles passes in between the shoulder bone and the collar bone. Certain motion will pinch on the muscle. The rotator cuff muscles can also be pinched in the front or back of the joint as well.
  • Instability from previous injury/trauma
  • Posture
  • Other (the shoulder is a very complicated joint. Your physiotherapist can assess it, and find out the root cause of your pain.)

Other Possible Diagnosis

Rotator cuff tendinitis can often be misdiagnosed because of its similarities with other shoulder conditions. Here are some other conditions that might cause your shoulder pain. (I will have an article soon talking about how you can differentiate one from another.)

  • Frozen Shoulder (a true frozen shoulder is not that common. Rotator cuff tendinitis is often misdiagnosed as frozen shoulder.)
  • Fracture
  • Referred Pain from Neck (this is a lot more common than you think)
  • AC Joint Dysfunction
  • Rotator Cuff Tear (Full or partial tear)

Associated Disorders

The following disorders can often co-exist with rotator cuff tendinitis.

  • Shoulder Bursitis
  • Long Head of Biceps Tendinitis
  • Shoulder Instability
  • Calcification of the Rotator Cuff Tendon

Common Treatment Options

  • Physiotherapy
    • Prognosis for rotator cuff tendinitis is good in physiotherapy. Patients usually make a complete recovery.
    • Diagnosing the root cause of the problem.
    • Manual therapy (joint mobilizations, muscle work, etc.)
    • Graded Strengthening and Stabilization exercises
    • Acupuncture and Dry-Needling
    • Shockwave Therapy
  • Cortisone injection
    • Can decrease the inflammation. It is often not a permanent solution, as the cause of the inflammation is not fixed. After the effects of the cortisone wears off, the inflammation might come back.
  • Anti-inflammatory medication
  • Surgery




About the Author:

Lily ZhangLily Zhang is a registered physiotherapist with training specializing in the McKenzie Method.  She graduated from McGill University and is currently working in Barrhaven (Ottawa, ON). She has over 10 years of professional training/clinical experience in orthopedic physiotherapy.  You can Follow Her Blog @PhysioVive Facebook Page.

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