Rotator Cuff Tendinopathy: What You Need To Know
What is Rotator Cuff Tendinopathy?
The rotator cuff (RC) is a group of muscles that help stabilize the shoulder joint and raise and rotate it. Rotator cuff tendinopathy is the degeneration, wear and tear, and inflammation of the tendon collagen of these muscles. It leads to pain, weakness, and stiffness making overhead and away from the body movements difficult. The cause of rotator cuff tendinopathy is multifactorial. Intrinsic, extrinsic, or combined factors may play a role in disease development. The disease includes rotator cuff tendinosis (degeneration) or tendinitis (inflammation) and is commonly present in people over thirty.
What are the causes of Rotator Cuff Tendinopathy?
The exact cause of rotator cuff tendinopathy remains unknown. So far, many causes have been explained, and, as a result, the disease appears to be multifactorial.
Mostly, extrinsic factors of the disease lead to compression of the tendons and narrowing of the subacromial space. These risk factors include:
- Postural abnormalities such as keeping the arms overhead for a long time
- Decrease in performance of shoulder muscles
- Muscle overuse in people who play sports or have an occupation that involves repetitive overhead movements
- Acromyan or subacromial anatomical variations
On the other hand, Intrinsic factors which lead to degeneration and wear and tear of the tendons are as follows:
- Changes in biology, morphology, vascularity, and mechanical properties
- Genetics and family history
- Old age
- Increase in load on the tendon (obesity)
What are the symptoms of Rotator Cuff Tendinopathy?
Rotator cuff tendinopathy signs and symptoms include:
- Dull, aching pain deep in the shoulder
- Pain triggered when raising and lowering the arm
- Shoulder joint stiffness
- Swelling and tenderness at the front of the shoulder and the side of the arm
- A clicking sound when raising the arm overhead
When the problem becomes severe, the following symptoms are present
- Pain at night that wakes the person up or requires them to change position
- Sharp pain when reaching behind the back or lifting something up
- Loss of joint strength and mobility
How to make a diagnosis of Rotator Cuff Tendinopathy?
Indeed, doctors make a diagnosis based on the following:
- Symptoms, their start, their occurrence, and their progression
- Medical history, recent falls, or any injuries
- Physical examination of the shoulder to check for tenderness, abnormalities, range of motion, etc.
- Strength of the shoulder joint by asking the patient to press against their hand
- X-ray to check for bone spur
- MRI or ultrasound to check for inflammation and signs of tearing or degeneration
Mostly, the imaging tests are usually performed to rule out other possible conditions.
What is the prognosis of Rotator Cuff Tendinopathy?
Recovery from the disease depends upon its severity. Usually, people see improvements within six to twelve weeks of rehabilitation. The minimum recovery time from a small tear is generally two to four weeks. But large tears may take months to recover. Ultimately, the aim is to reduce inflammation and compression of the tendon.
RC tendinopathy may cause long-term disability and chronicity if combined factors are involved. It badly affects the quality of life and may be associated with substantial morbidity.
What are reatment of Rotator Cuff Tendinopathy?
For minor to mild conditions, doctors recommend the following non-surgical treatments.
- Take non-steroidal anti-inflammatory drugs like ibuprofen, naproxen when symptoms flare-up
- Rest, and especially avoid activities that cause pain
- Apply ice to the shoulder for fifteen minutes, three or four times a day
- Apply heat once the pain goes away to lessen stiffness in the shoulder
- Avoid sleeping on the sore shoulder
Sometimes, a person may also benefit from over-the-counter analgesic ointments, creams, or patches such as menthol, capsaicin, and methyl salicylate.
What are interventional pain management options?
If RC tendinopathy is severe, doctors recommend a steroid injection into the shoulder joint. It relieves pain, improves sleep, and helps keep doing daily activities. But a steroid injection is a temporary solution and may weaken the joint in the long run.
Other than this, platelet-rich injection is a very good choice and more modern and preferable treatment for RC tendinopathy. Because it repairs the damaged tendon, it gives long-term results compared to intraarticular steroid injection.
What are the exercises for Rotator Cuff Tendinopathy?
Physical therapy is one of the first treatments doctors recommend. You may also see a physical therapist. Doctors or physical therapists recommend the following exercises:
- The weighted pendulum exercise w to reduce pressure on the rotator cuff muscles
- The crossover shoulder exercise
- Muscle strengthening exercises
- Stretching shoulder throughout the day
Most of the time, medication, rest, ice, and physical therapy is all that are needed to treat RC tendinopathy. Surgery is rarely performed and is the last resort. Its appropriateness depends upon age, the severity of the injury, physical demands, and overall health. Surgeries include tendon repair, tendon transfer, or shoulder replacement. Surgery has its own risks of anesthesia and surgical procedures and costly also. That is why non-surgical treatments are always preferable.