Rotator Cuff Tendinitis

Alternate Names
supraspinatus tendinitis
shoulder impingement syndrome

Definition of Rotator Cuff Tendinitis

Rotator cuff tendinitis is an inflammation of the tendons of the shoulder. A tendon is a fibrous band that connects muscles to bones. The muscles of the rotator cuff connect the humerus, or upper bone of the arm, to the shoulder. At the end of each muscle is a tendon that attaches the muscle to the bone. The four muscles of the rotator cuff are able to move bones by pulling on these tendons. These muscles and tendons allow movement and rotation of the arm and shoulder. Since these tendons are in frequent motion they are susceptible to injury, pain, and inflammation.

What are the signs and symptoms of the injury?

Symptoms of rotator cuff tendinitis include:

• shoulder pain, especially with movement and at night
• weakness in the arm and shoulder
• a snapping sensation in the shoulder with movement
• tenderness and swelling in the upper front part of the shoulder
• in severe cases, inability to raise the arm to shoulder height

What are the causes and risks of the injury?

The causes of rotator cuff tendonitis may include:

• injury to the shoulder joint or to the muscles of the shoulder
• the shoulder blade rubbing, pinching, or irritating the tendon
• repetitive stress injury, especially if the person's arm is repeatedly raised above the shoulder
• poor posture, which puts extra pressure on the muscles and tendons
• sudden increase in duration and intensity of exercising that involves the arm and shoulder
• calcium deposits in the rotator cuff
• musculoskeletal or inflammatory conditions, such as arthritis
• the normal aging process of the body

A person involved in sports before the injury may find a decrease in the normal range of motion in the shoulder. Chronic pain or soreness in the shoulder may occur. Rupture of the tendon is also possible.

What can be done to prevent the injury?

Prevention of rotator cuff tendinitis is related to the cause. For example, avoiding stress and overexertion can prevent many cases of rotator tendinitis. Sports safety guidelines for children, adolescents, and adults can be helpful in avoiding injuries. Many causes cannot be prevented.

How is the injury recognized?

The healthcare professional will want to know when the pain occurs, and if anything helps the pain. Based on the medical history and physical exam, the professional may order a number of tests, such as:

• joint x-ray
• MRI
• arthrogram or an arthroscopy, in which a small fiberoptic tube is inserted into the shoulder to allow the healthcare professional to see inside the joint
• blood tests, including a complete blood count (CBC), to check for infection
• biopsy of any fluid near the rotator cuff

What are the treatments for the injury?

Minor pain or injury involving the rotator cuff may require RICE therapy:

• rest or reduced activity
• ice or cold packs applied to the shoulder
• compression of the shoulder, such as with ace bandages
• elevation

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (i.e. Advil, Motrin) or naproxen (Naprosyn, Aleve, Anaprox, Naprelan), may be used to reduce inflammation and discomfort. In some cases, a corticosteroid, such as triamcinolone, may be injected into the shoulder.

Physical therapy helps to increase the strength of the tendons and muscles. Ultrasound may be used to warm the muscles and improve blood flow. If conservative treatment is not successful, surgery may be needed. Surgery called rotator cuff repair is done to relieve tendons that are being pinched by the shoulder blade.

What are the side effects of the treatments?

NSAIDs can cause stomach upset, ulcers, and bleeding, or allergic reactions. NSAIDs may also affect the liver and kidneys. Surgery can be complicated by bleeding, infection, or reactions to the anesthesia.

What happens after treatment for the injury?

In some individuals with rotator cuff tendonitis, no further treatment is needed for minor pain and inflammation. For more serious disease or injury, treatment may continue. After surgery, the person may need to rest for several days to several weeks. Follow-up care may be needed.

Physical therapy and daily strengthening exercises may be recommended. Any new or worsening symptoms should be reported to the healthcare professional.