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Rotator Cuff Tendonitis
Aka: Rotator Cuff Tendonitis, Rotator Cuff Tendinitis, Rotator Cuff Tendinopathy, Shoulder Impingement
- See Also
- Rotator Cuff Injury
- Course
- Step 1: Small cuff tears from repetitive use injury (Athlete, Heavy Laborer)
- Step 2: Tendon scarring and thickening
- Step 3: Secondary irritation of overlying bursa
- Step 4: Thickened tendon and bursa (decreases sub-acromial space)
- Step 5: Impingement pain and crepitus (Provoked with abduction)
- Symptoms
- Pain worse at night
- Shoulder tenderness and atrophy
- Unable to lie on affected Shoulder
- Locking Sensation with abduction
- Referred pain to deltoid
- Patient automatically turns palm up on abduction
- Externally rotates Shoulder
- Gives rotator cuff more room
- Active "palm down" abduction is painful
- Signs
- Supraspinatus insertion maximally tender
- Acromioclavicular Joint Pain from degenerative disease
- Muscle Strength intact
- Pain and crepitation
- Pain worse between 60 to 120 degrees abduction
- Soft tissue maximally compressed in subacromial space
- Shoulder Impingement Signs
- See Shoulder Evaluation
- Imaging: Shoulder XRay
- Sclerosis at tuberosity may be seen
- Hook Acromion (Types 2-3) associated with impingement
- Differential Diagnosis
- Rotator Cuff Rupture
- Rotator Cuff Calcification
- Management
- Relative Rest
- Avoid complete rest especially in older patients
- Risk of Frozen Shoulder
- Avoid excessive use
- Avoid all overhead work
- Sling for very limited time if necessary
- NSAIDs
- Moist heat applied 4 times daily
- Corticosteroid Injection at subacromial space
- Physical Therapy
- Local Ultrasound or Diathermy
- Phonophoresis (Ultrasound with Cortisone Cream)
- Exercise
- Shoulder Range of Motion Exercises
- Prognosis
- Anticipate improvement in 3 to 5 weeks
- Delayed improvement suggests Rotator Cuff Rupture
- Management: Surgery
- Reserved for cases failing conservative treatment
- Procedures
- Partial acromion excision
- Release of obstructive soft tissue
- Repair of Rotator Cuff Tears
- References
- Burbank (2008) Am Fam Physician 77:493-7 [PubMed]
- Childress (2013) Am Fam Physician 87(7): 486-90 [PubMed]
- Mantone (2000) Orthop Clin North Am 31:295-311 [PubMed]