The upper arm bone (humerus) is connected to the shoulder by muscles and tendons. Four of these muscle-tendon groups form the rotator cuff, which controls the rotation of the arm out away from the body and stabilizes the shoulder. The ‘cuff’ part comes from the four tendons merging together to then form a “cap” or “hood” around the head of the humerus. The head of this bone can be thought of as the ball in the ball-and-socket joint, which is your shoulder. This joint allows motion in a full circle, but this may be limited by tendinitis in the cuff.
The rotator cuff contains four muscles:
- Supraspinatus – controls internal rotation and lifting of the arm.
- Infraspinatus – allows you to externally rotate your arm in the shoulder socket.
- Teres minor – is a small muscle that helps rotate your arm.
- Subscapularis – controls arm abduction.
Rotator cuff tendinitis is also called impingement, bursitis, or biceps tendinitis. These are all different names for the same problem – they mean that there is pain and swelling of the cuff tendons and the surrounding bursa. The bursa is a soft sack that contains a small amount of fluid and cushions the joint.
Causes & Symptoms
The inflammation of key tendons in the shoulder is the most common cause of rotator cuff tendinitis. It is usually a gradual progression of irritation to the area. This condition can occur when you have loose joints, abnormal bony anatomy, perform heavy, repetitive lifting above the shoulder, or are an athlete who performs sports that require frequent overhead reaching. It can also be associated with a sudden injury to the area, or calcium build-up in the rotator cuff tendons.
The symptoms of rotator cuff tendinitis tend to worsen over time. These symptoms may be relieved with rest, but the symptoms can later become constant; some can even go past the elbow and normally indicate another problem. Some of these symptoms of rotator cuff tendinitis include:
- Pain and swelling in the front of your shoulder and side of your arm.
- Pain that is triggered by either raising or lowering your arm.
- A sudden clicking sound when you raise your arm constantly.
- A sudden feeling of stiffness.
- Pain that causes you to wake up from your sleep.
- Pain when reaching behind your back.
- A loss of mobility and strength in the affected arm.
Generally, the very first warning sign of rotator cuff tendinitis is pain and swelling of the bursa. Shoulder weakness and / or limited range of motion can also occur with long-term irritation or outright injury to the shoulder. The tendinitis can progress to a partial or complete tear of a tendon due to progressive weakening of the fibers.
How Gets Rotator Cuff Tendinitis?
Rotator cuff tendinitis may be grouped into two major areas: traumatic injuries and degenerative injuries. While traumatic injuries are one-time events, often unforeseeable accidents, degeneration occurs over time. Patients with degenerative rotator cuff injuries tend to have one or more of the following risk factors:
- Age – Degenerative injuries tend to occur in people over 40 and become increasingly more common as people age. Experts estimate that 15%-30% or more of people over age 70 have rotator cuff tendinitis.
- Shoulder arthritis – Patients with shoulder arthritis are more likely to develop shoulder instability, muscle weakness, and bony cysts, called osteophytes. All of these factors may put stress on the rotator cuff, making it more prone to developing this condition.
- Overuse – Degenerative injuries are more common in people who engage in repetitive overhead shoulder motions, such as hammering, painting, swimming, playing tennis, or pitching a baseball.
How Does It Affect You? How Serious Is It?
Rotator cuff tendinitis and rotator cuff tears are two very common types of injuries, meaning one condition can be mistaken for the other. For example, rotator cuff tendinitis often results from repetitive overhead motions such as throwing a ball, swimming, or swinging a racket.
An acute injury, such as falling or lifting something heavy, can tear rotator cuff tendons. However, in most cases, rotator cuff tears also occur gradually over time – as we age, tendons thin out and wear down (blood supply to the shoulder tendons also slows down); as a result, tiny tears do not repair themselves as effectively. Playing a sport or doing a job that requires repetitive overhead motions can also lead to tears over time.
Recommended Treatment & Rehabilitation
If you are having symptoms of rotator cuff tendinitis, it is recommended to visit a doctor as he / she will perform a physical examination of your shoulder – you will be checked to see where you’re feeling pain and tenderness. Your doctor will also test your range of motion by asking you to move your arm in certain directions.
Your doctor may also test the strength of your shoulder joint by asking you to press against their hand. They will finally examine your neck to check for conditions such as pinched nerve or arthritis that can cause symptoms similar to rotator cuff tendinitis.
Your doctor may order imaging tests to confirm the diagnosis of rotator cuff tendinitis and help rule out any other causes of your symptoms. An X-Ray may be ordered to see if you have a bone spur. He / she may also order an ultrasound or MRI scan to check for inflammation in your rotator cuff and signs of any tearing.
It is important to get proper treatment for tendinitis as soon as it occurs – over time, a degenerated tendon that is not treated can begin to tear, causing a more serious condition. Physiotherapy can be very successful in treating rotator cuff tendinitis, tendinosis, and shoulder impingement syndrome. You will work with your physiotherapist to devise a treatment plan that is specific to your condition and goals. This treatment program may include the following:
Your physiotherapist will help you identify and avoid painful movements to allow the inflamed tendon to heal. Ice, massage, or moist heat may be applied for pain management. Therapeutic modalities, such as electrical stimulation (TENS) may be applied.
Posture education is an important part of rehabilitation. For example, when your shoulders roll forward as you lean over a computer, the tendons in the front of the shoulder can become pinched. Your physiotherapist may recommend adjustments to your workstation and work habits. Your physiotherapist will also instruct you in ideal sitting, standing, and sleeping positions to help alleviate symptoms. Your therapist may suggest different ways to perform currently painful activities and show you movements to avoid while the shoulder is in a painful condition.
You will learn exercises and stretches to help your shoulder and shoulder blade move properly, so you can return to reaching and lifting without pain.
As your symptoms improve, your physiotherapist will help you return to your previous level of function, which may include household chores, job duties, and sports-related activities. Functional training can include working or lifting a glass into a cupboard or throwing a ball using proper shoulder mechanics.
Your physiotherapist may use manual techniques, such as gentle joint movements, soft-tissue massage, and shoulder stretches, to get your shoulder moving again with your shoulder blade.
Conservative treatments such as rest, ice, and physiotherapy, sometimes are all that’s needed to help recover from rotator cuff tendinitis. If your injury is severe, surgery is a more recommended option.
Most cases of tendinitis of the shoulder will not need surgery. However, if your symptoms are severe and do not improve with other treatments, your doctor may suggest surgery. Rotator cuff surgery can be performed to help remove the inflamed bone and tissue. These are two types of rotator cuff surgery:
- Arthroscopic surgery – This is a minimal surgery that is invasive and good for mild cases of tendinitis.
- Open surgery – which is only done in severe cases and replaces some of the damaged tissue.
Performing the right exercise for rotator cuff tendinitis is important during recovery since these muscles are essential for everyday function. Here are some exercises for anyone to try:
Bend over at the waist and let the arm-hand down passively. Using your body to initiate movement, swing the arm gently forward and backward and in a circular motion. Perform this pendulum exercise for several minutes, then repeat 3-5 times a day.
Isometric shoulder external rotation
Standing in a doorway with your elbow bent at a 90-degree angle and the back of your wrist pressing against the door frame, try to press your hand outward into the door frame. Hold this position for about 5 seconds, then repeat the exercise 3 times a day.
Isometric shoulder internal rotation
Standing in a doorway with your elbow bent at a 90-degree angle and the front of your wrist pressing against the door frame, try to press your palm into the door frame. Hold for 5 seconds, then do 3 more sets of 10 repetitions a day.
Stand with your arms at your sides and with your elbows straight. Slowly raise your arms to eye level. As you raise your arms, they should be spread apart so that they are only slightly in front of your body (at about 30-degree angle to the front of your body). Point your thumbs toward the ceiling. Hold this stretch for 2 seconds and lower your arms slowly before repeating the exercise with 3 sets of 10 repetitions.
Side-lying external rotation
Lie on one side with your top arm at your side and your elbow bent to 90 degrees. Keep your elbow against your side, raise your forearm and hold for 2 seconds. Slowly lower your arm, then do 3 more sets of 10 repetitions.
Alternative & Homeopathic Treatment
There are plenty of ways for you to alleviate your shoulder pain in general. The key to this process is understanding that some movements and exercises can be very helpful, while others can harm your shoulder and should be avoided. Here are some homeopathic treatments to help relieve your rotator cuff pain:
- Cold therapy – Applying ice reduces blood flow, which will decrease inflammation and swelling, and alleviate pain in the process; cold therapy is recommended immediately after pain strikes, and ice packs should be applied for 15-20 minutes, up to 5 times a day.
- Heat therapy – Applying heat to a painful shoulder increases blood flow and brings in oxygen and nutrients to the area, which will accelerate the healing process and alleviate pain; this is recommended a few days after the onset of pain and can be accomplished with an added hot shower directly on the shoulder or a hot pack applied to the affected area for 15-20 minutes a day.
- Over-the-counter medications – Some patients with mild rotator cuff tendinitis can experience relief with pain medications that do not require a prescription, particularly non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and naproxen; NSAIDs may alleviate pain by reducing inflammation.
- Sleeping style – Sleeping on your bad shoulder can make matters much worse, so it is recommended to try to sleep on your back or the side of your body that is unaffected by shoulder pain to avoid worsening the problem.
- Massage therapy – Gently massaging your shoulder will help alleviate stress and tension in the surrounding muscles, whilst also improving blood circulation and reducing swelling in the process, all of which can reduce your pain levels.