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Shoulder tendonitis from rotator cuff tendonitis (also called rotator cuff tendinopathy or rotator cuff tendonosis) is exceedingly common affecting at least 20 per cent of the population at some point.
The shoulder is a partial ball and socket joint with the head of the humerus (upper arm bone) being held in place inside a shallow cup formed by the glenoid labrum of the scapula (shoulder blade). Stability of the humeral head is achieved by ligaments, tendons, and muscles of the rotator cuff. The shoulder joint is extremely mobile but it also less stable than other joints such as the hip. In addition, because the space between the roof of the shoulder and the humeral head is narrow, there is the potential for rotator cuff problems including compression of muscles and tendons. The shoulder is surrounded by a series of fluid-filled sacs (bursae) which act to cushion the joint. So… it is easy to see that shoulder pain can arise from many different structures including the tendons, bursae, muscles, ligaments, and nerves. Rotator cuff disorders commonly occur with rotator cuff tendons and are among the most common cause of shoulder pain seen in clinical practice. Rotator cuff syndrome can run the gamut from tendonitis, to rotator cuff impingement (pinching of the rotator cuff between the acromion of the shoulder blade and the humeral head), to adhesive capsulitis (frozen shoulder), to rotator cuff tear. The history often provides valuable information. Shoulder pain due to rotator cuff injury is aggravated by movement. Night pain is common and patients often have difficulty finding a comfortable position in which to sleep. A history of overuse (“weekend warrior syndrome”) may point towards a diagnosis of bursitis or rotator cuff strain (tendonitis). Trauma might indicate the presence of fracture, dislocation, or rotator cuff tear.Physical examination can determine range of motion as well as the possibility of rotator cuff dysfunction. Patients who have significant arthritis in any of the shoulder joints (glenohumeral=joint between the humerus and scapula; acromioclavicular=the joint between the scapula and the clavicle; sternoclavicular=joint between the sternum and the clavicle) will have tenderness and possible swelling localized to that joint. Patients with severe glenohumeral arthritis will have marked reduction in range of motion and even grinding with movement of the arm.
The biceps tendon is another major tendon that is located at the front of the shoulder. While it is not considered a rotator cuff tendon, this structure will often develop problems. Biceps tendonitis or bicipital tendonitis are the terms used to describe tendonitis located here.As noted earlier, a careful general physical exam is needed because of the possibility of pain referral from other areas.Diagnostic testing is based on what is seen on exam and what is gleaned from history. It is difficult occasionally to separate rotator cuff tendonitis from rotator cuff tear symptoms. This is particularly true when rotator cuff injury occurs in older women.
There are many causes of a torn rotator cuff... not the least of which is age. X-ray imaging is of value only for fracture or dislocation. X-rays are not useful at all for determining rotator cuff damage and treatment. Magnetic resonance imaging is the preferred method of imaging for diagnosis that is helpful in guiding shoulder bursitis and tendonitis treatment. Proper rotator cuff therapy depends on the underlying diagnosis. For patients with impingement, bursitis, or rotator cuff syndrome, anti inflammatory drugs, rest with a sling, and physical therapy may be helpful. Glucocorticoid injection under ultrasound guidance can also be of immense value. Calcium deposits on the rotator cuff may require a different treatment.Common questions that are asked include, “How do I fix a rotator cuff injury?” and “Can a torn rotator cuff heal?” New treatments using ultrasound guided needle placement, platelet derived growth factors, and polymers alternative therapies to surgery for rotator cuff injury and show the potential for healing full rotator cuff tears.
Another frequently asked question is “How do I rehabilitate a rotator cuff injury?” Specific shoulder tendonitis exercises can be very helpful for many patients with mild to moderate problems.
Rotator cuff surgery is reserved for patients with severe impingement or rotator cuff problems unresponsive to conservative measures, large rotator cuff tears, or severe arthritis.Procedures include removal of the clavicle in the area of rotator cuff impingement (acromioplasty), rotator cuff repair, removal of inflamed synovium, or joint replacement.
Treating biceps tendonitis is somewhat similar to treating rotator cuff problems.