Rotator cuff tendinitis describes the inflammatory response of one, several, or all of the four the rotator cuff tendons due to impingement or overuse. It is a common source of the painful shoulder characterized by overuse that causes repeated micro trauma to a tendon and it’s resultant inflammatory response. This inflamed condition precedes a process that could lead to a rupture of the tendon. The subsequent thickening of the tendons brought on by inflammation often causes the rotator cuff tendons to become trapped under the acromion, causing subacromial impingement. Failure of the healing process leads to further damage to the tissue and eventual tendinopathy. Early care and rehabilitation of tendinitis is necessary to prevent the development of more chronic and serious conditions. This page is designed to provide a clinically relevant overview of the areas pertinent to rotator cuff tendinitis and treatment.
The rotator cuff is comprised of four muscles: supraspinatus m., infraspinatus m., teres minor m., and subscapularis m. These four relatively small muscles play a vital role and work together in shoulder stabilization of the humeral head in the glenoid fossa, initiation of arm movement, and controlled function of the upper extremity. Tendinitis of the rotator cuff can be inflammation to any or all of the muscles of the rotator cuff, the most common of which is supraspinatus.
Incidence & Prevalence 7,8
Rotator cuff tendinitis describes the inflammation associated with tendinopathy, a painful and impaired shoulder, and represents the beginning stages of rotator cuff disorder, which is the most common problem of the shoulder. High body mass index and certain metabolic factors as well as tobacco use trends toward an elevated incidence of rotator cuff tendinitis. Overhead athletes tend to have a higher incidence of overuse injury while the aging population prevalence is secondary to subacromial joint space narrowing due to age or postural deformity.
Potential Etiologies 4,8,13
Repeated overuse under stress and loaded overhead use as seen in over head dominant sports, occupations, and recreational activity such as swimming, pitching, throwing, volleyball, carpentry, general labor, and stockers. Subacromial impingement of any of the tendons will result in micro trauma to that area, causing inflammation. Overhead athletes may be at particular disposition due to increased external rotation range, increased retroversion of the humerus and glenoid, and anterior laxity.
Clinical Presentation 4,8,9,13
- Pain with rotation, especially against resistance
- Pain with abduction, especially at or above 90 degrees
- Pain at rest/night
- Pain limited weakness
Evaluation & Testing 1,8,9,11,12
- Pain with movement
- Neers Test
- Hawkins-Kennedy Test
- Supraspinatus Test
Typical Medical Management 1,2,3,4,8,9,10
- P.R.I.C.E. Guidelines
- Corticosteroid Injection
- Subacromial Decompression Surgery
- Indirect suprascaplular nerve block
Other Pathological Associations with Rotator Cuff Tendonitis
- Rotator cuff tear
- Calcific Rotator Cuff Tendinitis
- Bicipital Tendinitis
Additional Web-based Resources
1. Kibler, W. Rehabilitation of rotator cuff tendinopathy. Clin Sp Med. 2003;22(4):837-847. Available at: http://linkinghub.elsevier.com/retrieve/pii/S0278591903000486.
2. What to do about rotator cuff tendinitis. Harv Womens Health Watch. 2007;14(11):4-5. http://search.ebscohost.com/login.aspx?direct=true&db=jlh&AN=2009618049&site=ehost-live.
3. Di Lorenzo L, Pappagallo M, Gimigliano R, et al. Pain relief in early rehabilitation of rotator cuff tendinitis: Any role for indirect suprascapular nerve block? EUROPA MEDICOPHYSICA. 2006;42(3):195-204. http://search.ebscohost.com/login.aspx?direct=true&db=jlh&AN=2009509271&site=ehost-live.
4. Drakos MC, Rudzki JR, Allen AA, Potter HG, Altchek DW. Internal impingement of the shoulder in the overhead athlete. J BONE JOINT SURG (AM). 2009;91(11):2719-2728. http://search.ebscohost.com/login.aspx?direct=true&db=jlh&AN=2010459809&site=ehost-live. doi: 10.2106/JBJS.I.00409.
5. Magee, DJ. Orthopedic physical assessment, 5th ed. Philadelphia: WB Saunders Co, 2008
6. Onieal M. Question and answer: Rotator cuff tendinitis. J Am Acad Nurse Pract. 1994;6(7):339-340. http://search.ebscohost.com/login.aspx?direct=true&db=jlh&AN=1994197340&site=ehost-live.
7. Rechardt M, Shiri R, Karppinen J, Jula A, Heliövaara M, Viikari-Juntura E. Lifestyle and metabolic factors in relation to shoulder pain and rotator cuff tendinitis: A population-based study. BMC Musculoskelet Disord. 2010;11:165-165. http://search.ebscohost.com/login.aspx?direct=true&db=jlh&AN=2010747667&site=ehost-live. doi: 10.1186/1471-2474-11-165.
8. Seitz AL, McClure PW, Finucane S, Boardman ND 3rd, Michener LA. Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both? Clinical biomechanics (Bristol, Avon). 2011;26(1):1-12. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20846766. Accessed August 20, 2011.
9. Bennell, K. Wee, E. Coburn, S. Green, S. Harris, A. Staples, M. Forbes, A. Buchbinder, R. Efficacy of standardised manual therapy and home exercise programme for chronic rotator cuff disease: randomised placebo controlled trial. Bmj. 2010;340(jun08 2):c2756-c2756. Available at: http://www.bmj.com/cgi/doi/10.1136/bmj.c2756. Accessed July 23, 2011.
10. Eyigor, C. Eyigor, S. Kivilcim Korkmaz, O. Are intra-articular corticosteroid injections better than conventional TENS in treatment of rotator cuff tendinitis in the short run? A randomized study. European journal of physical and rehabilitation medicine. 2010;46(3):315-24. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20926997.
11. Hawkins RJ, Kennedy JC. Impingement syndrome in athletes. Am J Sports Med 1980;8:151–8
12. Neer CS, 2nd. Impingement lesions. Clin Orthop Relat Res 1983;(173):70–7.
13. Fu SC, Rolf C, Cheuk YC, Lui PP, Chan KM. Deciphering the pathogenesis of tendinopathy: a three-stages process. Sports medicine, arthroscopy, rehabilitation, therapy & technology : SMARTT. 2010;2:30. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3006368&tool=pmcentrez&rendertype=abstract.