Rotator Cuff Tendonitis / Tendonopathy / Impingement

Rotator Cuff

• rotator cuff comprised of four muscles acting together with larger shoulder muscles to power movement of arm, each in specific directions (shoulder is most complex functional unit in body and permits extensive, multidimensional range of motion) and to provide dynamic shoulder joint stability by way of soft tissue versus bony support (very shallow socket)
• Supraspinatus muscle originates on scapula (shoulder blade) with tendon passing over and attaching to lateral aspect of head of humerus (bone of upper arm); Infraspinatus and Teres Minor both take origin from scapula and proceed laterally past axilla (armpit) to attach onto humerus; Subscapularis originates from undersurface of scapula, passes through axilla and inserts onto front aspect of humerus

Rotator Cuff Tendonitis/Tendonopathy/Impingement

• Supraspinatus and Biceps tendons and subacromial bursa commonly injured due to position within subacromial space (narrow canal between opposing bony surfaces of humerus and acromion – arched projection of scapula) or presence of calcium; Biceps tendon sheath (encloses and lubricates tendon as it pierces joint capsule to attach inside joint) may become inflamed through over/misuse of shoulder
• when tendon is damaged by trauma or overuse it swells occupying more space in already narrow canal and pinching occurs, further limiting blood supply to tendon
• impingement may occur with repetitive or sustained overhead and inward rotating arm activity (e.g., swimming, baseball, volleyball, tennis)

Physical Therapy Treatment

• assessment to identify affected tissue (deficits in movement and/or strength following injury are specific to affected tendon and its particular function)
• application of electrotherapeutic modalities and ice
• transverse frictions to initiate healing and mobilize scar tissue
• progressed postural core and other muscle strengthening (to address strength deficit or imbalance) and stretch exercises demonstrated and assigned; respect pain

Other Treatments

• anti-inflamamatory and pain medications
• steroid injection(s) in cases in which condition persists and is otherwise not responsive to conservative treatment
• surgical repair of damaged tissue or modification of encroaching bony structure (xray may reveal hypertrophy, spurring, or downward angulation of acromion)
• acupuncture to aid in reducing pain and increasing mobility

Prognosis

• six visits on alternate days basis is typically recommended
• more severe tear, +/-inflammation and/or surgical intervention, predictive of longer recovery process
• ongoing constant use and misuse of limb may well delay recovery; 'guarding', or not using arm at all, may result in 'freezing' of joint (frozen shoulder)

Physio Note: Sleeping and Exercise

Try not to spend long periods sleeping on the affected side. Sleeping with the arm above your head is also to be avoided as it can compress the cuff tendons and thereby compromise blood flow needed for healing

It is important to avoid provocative overhead activities or those that work the arm fully outstretched and rotated inward. Your physical therapist will help identify the offending activity and assign a series of progressed stretch and strengthening exercises