Are you dealing with persistent shoulder pain, stiffness, or limited range of motion? Are you concerned that it may be rotator cuff tendonitis or a rotator cuff tear? When left untreated, these conditions can significantly reduce mobility and quality of life. Fortunately, diagnosis and treatment can help to minimize your symptoms and restore your strength. In this blog post, we will discuss the signs and symptoms of rotator cuff tendonitis and rotor cuff tears, as well as options for diagnosis and treatment. The orthopedic surgeons at OrthoNeuro can give you a proper diagnosis and tailored treatment for your shoulder pain. Contact one of our offices in Columbus, Ohio for expert medical care today!
The shoulder is composed of the humerus (upper arm), clavicle, and scapula bones. The humerus sits in the glenoid fossa of the scapula, which comprises the glenohumeral joint.
There are four rotator cuff muscles that attach to the humerus: supraspinatus, infraspinatus, teres minor, and subscapularis. In addition to allowing internal and external rotation of the shoulder, the muscles also prevent the humeral head from dislocating out of the socket.
Rotator cuff pathology is a common cause of shoulder pain. The two common presentations of rotator cuff pathology include tendinitis and tearing.
Shoulder tendonitis (also known as shoulder impingement syndrome) is a common finding in individuals who do a lot of overhead activity—particularly young athletes in sports like swimming, tennis, volleyball, etc, are at risk for this pathology.
The supraspinatus tendon, which connects the muscle belly to the bony landmark on the humerus, is especially vulnerable due to its course under the acromion bone, where it can be impinged. There is also a bursal tissue in the area, which is a fluid sac, that allows seamless slipping of the tendon during overhead motion.
Repetitive activities, though, can lead to inflammation of the bursa (shoulder bursitis) or tendon (tendonitis), which constricts the space more than baseline during overhead motion.
A US with active movement or MRI can be used to evaluate these causes. The clinical tests that elicit the pain put the shoulder in the impinged position, but they typically do not point to a specific cause.
Treatment can be conservative, including NSAIDs, injections (cortisone or PRP), and physical therapy based on pathology.
Rotator cuff tears are typically from acute injury or thinning of the tendon. Acute injury includes things like slipping on an outstretched hand or lifting heavy objects. The thinning can come from insult due to overuse. In addition, as we age, less blood supply is provided to the tendons, so they naturally thin out.
Clinical tests isolate the rotator cuff muscle to check its strength. A US or MRI image is used to diagnose a tear. Typically, an MRI can better determine if it’s a partial-thickness or full-thickness tear, which is important for deciding treatment options.
Treatment typically includes first-line injections, physical therapy, and NSAIDS, as before. Additionally, a rotator cuff repair can be done using small incisions (arthroscopic). The technique itself varies by surgeon, but the goal is to attach the tendon back to the humeral head.
Recovery after surgery will include three stages. First, the joint is immobilized to allow for initial rotator cuff tendon healing back to bone. Second, a physical therapist will passively move the arm to preserve range of motion. Lastly, the active phase is where the patients need to regain strength through active exercises.
Ideally, recovery is 4-6 months for the surgery. Importantly, the chance of retear is higher for patients with a previous tear. Thus, both appearance and tear history of the tendons are important deciding factors in choosing a more invasive reverse shoulder replacement instead of rotator cuff repair.
Trust OrthoNeuro for expert diagnosis and treatment for your shoulder pain. Our orthopedic surgeons have a wealth of experience in dealing with shoulder conditions. You can find us throughout Columbus, Ohio. Contact us today!
Marovino T. Use of Ultrasound in Detection Of Rotator Cuff Tears. Pract Pain Manag. 2013;13(8).
“MRI of Torn Rotator Cuff.” Mayo Clinic, www.mayoclinic.org/diseases-conditions/rotator-cuff-injury/multimedia/mri-of-torn-rotator-cuff/img-20130558. Accessed 7 Aug. 2023.
“Rotator Cuff Tears – Orthoinfo – Aaos.” OrthoInfo, orthoinfo.aaos.org/en/diseases–conditions/rotator-cuff-tears/. Accessed 7 Aug. 2023.
Medically Reviewed by Scott Stephens, MD
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