Shoulder
Rotator Cuff Tendonitis
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Rotator Cuff Tendonitis
, Rotator Cuff Tendinitis, Rotator Cuff Tendinopathy, Shoulder Impingement
See Also
Rotator Cuff Injury
Course
Step 1: Small cuff tears from repetitive use injury (Athlete, Heavy Laborer)
Step 2: Tendon scarring and thickening
Step 3: Secondary irritation of overlying bursa
Step 4: Thickened tendon and bursa (decreases sub-acromial space)
Step 5: Impingement pain and crepitus (Provoked with abduction)
Symptoms
Pain worse at night
Shoulder
tenderness and atrophy
Unable to lie on affected
Shoulder
Locking
Sensation
with abduction
Referred pain to deltoid
Patient automatically turns palm up on abduction
Externally rotates
Shoulder
Gives rotator cuff more room
Active "palm down" abduction is painful
Signs
Supraspinatus insertion maximally tender
Acromioclavicular
Joint Pain
from degenerative disease
Muscle Strength
intact
Pain and crepitation
Pain worse between 60 to 120 degrees abduction
Soft tissue maximally compressed in subacromial space
Shoulder Impingement Signs
See
Shoulder
Evaluation
Imaging
Shoulder XRay
Sclerosis at tuberosity may be seen
Hook Acromion
(Types 2-3) associated with impingement
Differential Diagnosis
Rotator Cuff Rupture
Rotator Cuff Calcification
Management
Relative Rest
Avoid complete rest especially in older patients
Risk of
Frozen Shoulder
Avoid excessive use
Avoid all overhead work
Sling for very limited time if necessary
NSAID
s
Moist heat applied 4 times daily
Corticosteroid Injection
at subacromial space
Physical Therapy
Local
Ultrasound
or Diathermy
Phonophoresis
(
Ultrasound
with
Cortisone
Cream)
Exercise
Shoulder Range of Motion Exercises
Prognosis
Anticipate improvement in 3 to 5 weeks
Delayed improvement suggests
Rotator Cuff Rupture
Management
Surgery
Reserved for cases failing conservative treatment
Procedures
Partial acromion excision
Release of obstructive soft tissue
Repair of
Rotator Cuff Tear
s
References
Burbank (2008) Am Fam Physician 77:493-7 [PubMed]
Childress (2013) Am Fam Physician 87(7): 486-90 [PubMed]
Mantone (2000) Orthop Clin North Am 31:295-311 [PubMed]
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