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Rotator Cuff Tendinitis
Dr Kau Chung Yuan (许医生)
MBBS (S’PORE)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
What is Rotator Cuff Tendinitis?
Rotator cuff tendinitis, also known as rotator cuff tendinopathy or shoulder tendinitis, is a condition characterised by irritation or inflammation of the tendons in the rotator cuff. The rotator cuff is a group of muscles and tendons surrounding the shoulder joint, which provides stability and facilitates a wide range of shoulder movements.
This condition primarily affects the tendons, rather than the muscles, leading to pain and discomfort in the shoulder area. It commonly occurs in individuals who engage in repetitive overhead motions in their daily activities or professions, such as athletes, painters, and construction workers.
Causes
Rotator cuff tendinitis stems from various factors, predominantly related to overuse and strain of the shoulder tendons. The primary causes are:
- Repetitive Strain: Activities involving continuous repetitive overhead motions, commonly found in certain sports and occupations, lead to stress on the rotator cuff tendons.
- Age-related Degeneration: The tendons’ blood supply diminishes with age, making them more prone to wear and tear, a common cause in older adults.
- Acute Injury: Sudden injuries to the shoulder can lead to tendinitis, especially if followed by excessive use during recovery.
- Poor Posture: Chronic poor posture, such as prolonged computer use, can result in shoulder imbalances, increasing strain on the tendons.
- Lack of Muscle Flexibility or Strength: Insufficient shoulder muscle flexibility or strength can disrupt shoulder mechanics, heightening the risk of tendinitis.
Symptoms
The symptoms of rotator cuff tendinitis can vary in intensity but typically include:
- Shoulder Pain
Often the first and most common symptom, pain is usually felt in the front of the shoulder and may radiate down the arm. It can be exacerbated by certain movements, especially overhead activities. - Swelling and Tenderness
The affected area may exhibit swelling and tenderness, particularly noticeable upon touch or movement. - Reduced Range of Motion
Individuals may experience a decrease in shoulder mobility, finding it difficult to perform movements like reaching behind or lifting objects. - Weakness in the Shoulder
There might be a noticeable weakness when lifting or rotating the arm, impacting daily activities. - Night Pain
Pain that intensifies during the night or while lying on the affected side is a common symptom, often disturbing sleep. - Crepitus
A cracking or popping sensation in the shoulder during movement can sometimes be felt or heard.
Diagnosis
Diagnosing rotator cuff tendinitis involves a combination of clinical evaluation and diagnostic tests:
Medical History and Physical Examination
The initial step often involves a detailed discussion of symptoms, medical history, and a physical examination, focusing on the shoulder. The orthopaedic surgeon may perform specific movements to assess pain, range of motion, and shoulder strength.
Imaging Tests
- X-rays: While X-rays cannot show soft tissues like tendons and ligaments, they can help rule out other causes of shoulder pain, such as arthritis or bone spurs.
- Ultrasound: This imaging technique is useful for viewing soft tissues and can help detect inflammation in the rotator cuff tendons.
- Magnetic Resonance Imaging (MRI): MRI provides detailed images of both soft and hard tissues, allowing for a comprehensive evaluation of the rotator cuff.
Response to Treatment
Sometimes, the diagnosis is supported by the patient’s response to initial treatment, such as rest, ice, and anti-inflammatory medications.
Non-Surgical Treatment Options
The majority of rotator cuff tendinitis cases can be effectively managed with non-surgical treatments, focusing on relieving pain and restoring shoulder function:
Rest and Activity Modification
Avoiding activities that exacerbate shoulder pain is crucial. Modifying daily routines to reduce strain on the shoulder can aid significantly in recovery.
Cold Packs and Heat Therapy
Applying cold packs can reduce inflammation and pain, especially after activity. Heat therapy may be used to relax tight muscles around the shoulder.
Physical Therapy
Tailored exercises, designed by a physiotherapist, can strengthen the shoulder muscles, improve flexibility, and restore range of motion.
Pain Relief Medications
Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can be used to manage pain and reduce inflammation.
Corticosteroid Injections
In cases of severe pain, corticosteroid injections may be recommended. These injections provide temporary relief from pain and inflammation.
Ultrasound Therapy
This treatment uses sound waves to promote healing and reduce inflammation in the tendons.
Surgical Treatment Options
Surgical intervention for rotator cuff tendinitis is considered when non-surgical treatments fail to provide relief, or in cases of severe tendon damage. The main surgical options include:
- Arthroscopic Tendon Repair
A minimally invasive procedure where small incisions are made, and an arthroscope (a small camera) is inserted to guide the repair of the tendon. - Open Tendon Repair
In more severe cases, a traditional open surgical approach may be required to repair the damaged tendon. - Tendon Transfer
If the tendon damage is extensive, a tendon transfer, where a nearby tendon is used to replace the damaged one, may be considered. - Shoulder Replacement
In cases where rotator cuff tendinitis is accompanied by severe arthritis, a partial or total shoulder replacement might be necessary.
Dr. Kau Chung Yuan
MBBS (S’pore)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
Dr Kau (许医生) is a Fellowship trained Orthopaedic Surgeon with a subspecialty interest in Hip and Knee surgery and has been in practice for more than 15 years.
He is experienced in trauma and fracture management, sports injuries, and joint replacement surgery.
- Fellow of the Royal College of Surgeons Edinburgh, Orthopaedics (FRCS, Edin) 2014
- Master of Medicine (Orthopaedics), Singapore (MMed) 2013
- Member of the Royal College of Surgeons Ireland (MRCS, Ire) 2009
- Bachelor of Medicine and Surgery (MBBS, Singapore) 2004
Prevention Measures
Preventing rotator cuff tendinitis involves measures aimed at reducing the strain on the shoulder tendons. Key prevention strategies include:
- Regular Exercise: Strengthening and stretching exercises for the shoulder can improve flexibility and stability, reducing the risk of tendon irritation.
- Proper Technique in Activities: Using the correct technique in sports and occupational activities, especially those involving overhead motions, can minimise undue stress on the shoulder.
- Ergonomic Adjustments: Making ergonomic changes to the workplace, particularly for desk-bound professionals, can help in maintaining a posture that reduces shoulder strain.
- Taking Breaks: Regular breaks during activities that involve repetitive shoulder movements can prevent overuse.
- Warm-up and Cool-down Routines: Incorporating warm-up exercises before and cool-down stretches after physical activity can prepare the muscles and tendons for the stress of exercise.
- Maintaining a Healthy Weight: Excess body weight can put additional stress on the shoulder joints and tendons.
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Frequently Asked Questions (FAQs)
Can rotator cuff tendinitis heal on its own?
Rotator cuff tendinitis can often heal on its own if given adequate rest and proper care. However, this is contingent on the severity of the condition and adherence to recommended rest and treatment protocols.
Recovery timelines can vary widely, typically ranging from a few weeks to several months, depending on individual health factors, the extent of tendon involvement, and lifestyle adjustments made to facilitate healing.
How long does it take to recover from rotator cuff tendinitis?
Mild cases may resolve within a few weeks, while more severe or chronic conditions could take several months to fully recover. Adherence to a structured physical therapy program, proper rest, and avoidance of aggravating activities are crucial for recovery.
Can rotator cuff tendinitis lead to a rotator cuff tear?
Untreated rotator cuff tendinitis can escalate to a rotator cuff tear, particularly if the shoulder continues to be exposed to the strain or stress that initially caused the tendinitis. Continuous overuse or repetitive strain can lead to the weakening and degeneration of the rotator cuff tendons.
This degenerative process increases the likelihood of a tendon tear, especially in older individuals or those engaged in high-impact or repetitive overhead activities. Therefore, timely and effective treatment of tendinitis is crucial to prevent its progression to a more serious rotator cuff tear.
Can rotator cuff tendinitis recur?
Rotator cuff tendinitis can recur, particularly if the underlying causes, such as repetitive overhead activities, poor posture, or inadequate shoulder mechanics, are not adequately addressed and corrected. Recurrence can also occur if the initial episode is not fully healed before resuming regular activities.
Implementing preventative strategies, such as regular shoulder strengthening and flexibility exercises, proper ergonomic adjustments during work or activities, and maintaining a healthy lifestyle, can reduce the risk of recurrence. Being mindful of early signs and seeking prompt treatment can help in managing recurrent episodes effectively.