Rotator Cuff Tendinitis

The rotator cuff tendons stabilize the shoulder joint by attaching muscles originating at the shoulder blade to the head of the humerus (upper arm bone). There are four tendons in the rotator cuff that help control arm rotation and elevation: the supraspinatus, the subscapularis, the infraspinatus and the teres minor.

Damage to the rotator cuff is the most common cause of shoulder pain. The rotator cuff tendons are commonly irritated with repetitive overhead activities and routine lifting that may result in pain and weakness in the shoulder.

Tendinitis is most often diagnosed as an overuse repetitive strain injury (RSI), but most RSI cases exhibit genetically predisposing factors as well. Individuals that have a poor blood supply to the area are most susceptible to inflammation and the development of tendinitis (for example, the supraspinatus). Other high-risk activities or conditions that may lead to the development of shoulder tendonitis include:

• Participation in activities requiring overhead motions like swimming, tennis, softball and baseball.
• Repetitive strain injuries (RSI) at work are common in patients performing activities habitually, such as assembly line work.
• Sudden injury to the region like landing on the shoulder.
• Patients suffering from rheumatoid arthritis may have an increased risk to tendinitis.
• Aging, resulting in changes to tendon elasticity and circulation that increase the susceptibility to injury and reduce the ability to heal.
• Postural factors like leaning the head and shoulder forward, reducing the subacromial space, thus leading to irritation of the shoulder tendons
• Overload injuries derived from lifting heavy objects or weight training.
• Weakening of the rotator cuff, causing a muscular imbalance resulting in shoulder impingement (pinching).

• Pain, either acute or dull, when preforming motions and pain that lingers even when the shoulder is at rest.
• In more severe cases, pain that radiates to the upper arm and is accompanied by a burning sensation restricting movement.
• Tenderness and/or tightness of the area, especially to one’s touch.
• Difficulty sleeping on affected side and pain that worsens overnight.
• Reduction of ability to preform tasks essential to daily life, such as difficulty dressing.
• Increased weakness and swelling of the tendon as inflammation escalates.

If detected and treated early, many patients recover full function and range of the shoulder provided the patient is dedicated to the treatment program prescribed. Those patients dealing with a more involved situations such as impingement due to bone spurs, have high success rates with surgical decompression of the area. It is difficult to predict the outcome of tendon tears, as the success of rehabilitation is dependent on the size of the tear, integrity and elasticity of the tissue, patient age, preoperative condition of the patient and if the patient is experiencing any comorbid syndromes. Please refer to the Rotator Cuff Tear section for more information on tendon tears.

Small measures can be taken by at-risk individuals to help prevent tendinitis. It is far easier to prevent the condition than it is to treat it, as some damage may be irreversible or costly to fix. Below are some tips to reduce the risk of tendinitis:

• Warm-up for athletic activity gradually. This improves circulation and lubrication to the muscle and tendon. Remember to stretch after preforming strenuous activity as well.
• Do not bounce when stretching. Instead, hold the stretch for 15 to 20 seconds.
• Utilize a strength-training program to improve and stabilize the muscles and tendons used for activity. A regular strength-training program three times a week will increase muscle health and help reduce weakening brought on by aging.
• Always listen to your body – do not work through pain. Avoid the “no pain, no gain” philosophy as you may inflict serious damage to yourself. Pain is the body’s way of notifying you to stop what you are doing.