What to do about rotator cuff tendinitis

The best way to treat rotator cuff tendonitis, the most common cause of shoulder pain, is with simple home therapies.

Swinging a tennis racket, digging in the garden, placing a book on a high shelf, and reaching back to insert your arm into a sleeve — these are some of the movements made possible by the shoulder’s enormous range of motion. We use this mobility in so many activities that when the shoulder hurts, it can be disabling. For younger people, sports injuries are the main source of trouble, but the rest of us have more to fear from the normal wear and tear that, over time, weakens shoulder tissues and leaves them vulnerable to injury. The risk is greatest for people with occupations or hobbies that require repetitive or overhead movements, such as carpenters, painting, tennis, or baseball.

The most common cause of shoulder pain is rotator cuff tendonitis — inflammation of key tendons in the shoulder. The earliest symptom is a dull ache around the outside tip of the shoulder that gets worse when you push, pull, reach overhead, or lift your arm up to the side. Lying on the affected shoulder also hurts, and the pain may wake you at night, especially if you roll onto that shoulder. Even getting dressed can be a trial. Eventually, the pain may become more severe and extend over the entire shoulder.

When severe, tendonitis can lead to the fraying or tearing of tendon tissue. Fortunately, rotator cuff tendonitis and even tears can usually be treated without surgery.

Anatomy of the rotator cuff

The rotator cuff comprises four tendons — the supraspinatus, infraspinatus, teres minor, and subscapularis; each of them attaches a muscle of the same name to the scapula (shoulder blade) and the humerus, or upper arm bone (see illustration). The tendons work together to stabilize the joint, rotate the shoulder, and lift the arm above the head. Rotator cuff tendonitis usually starts with inflammation of the supraspinatus tendon and may involve the three other tendons as the condition progresses.

Rotator cuff diagnosis

Most clinicians diagnose rotator cuff tendonitis by taking a history and performing a physical examination. However, if you’ve suffered a traumatic injury or the shoulder hasn’t improved with conservative therapy, or if a tear is suspected, an x-ray or MRI may be ordered. Your clinician will also check for tenderness at a point near the top of the upper arm (the subacromial space) and look for pain as the arm is raised and moved in certain ways. Your muscle strength and the shoulder’s range of motion will also be tested. Pain with normal muscle strength suggests rotator cuff tendonitis; pain with weakness may indicate a tear (see “What about a rotator cuff tear?”). Because it’s difficult to assess strength when the shoulder hurts, your clinician may inject a numbing agent (lidocaine) to deaden the pain before making an evaluation.

Rotator cuff treatment

The minimum time for recovery from rotator cuff tendonitis or a small tear is generally two to four weeks, and stubborn cases can take several months. Early on, the aim is to reduce swelling and inflammation of the tendons and relieve compression in the subacromial space. Later, exercises can be started to strengthen the muscles and improve range of motion.

During the first few days of rotator cuff tendonitis, apply an ice pack to the shoulder for 15 to 20 minutes every four to six hours. If you still have a lot of rotator cuff pain, a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, may be helpful. Your clinician may also suggest a corticosteroid injection, but there’s no clear evidence that this offers any advantage in the long term over physical therapy and NSAID use.

While you’re in pain from rotator cuff tendonitis, avoid lifting or reaching out, up, or overhead as much as possible. On the other hand, you don’t want to stop moving your shoulder altogether, because that can lead to “frozen shoulder,” a condition in which the tissues around the shoulder shrink and reduce its range of motion.

Rotator cuff stretches

The weighted pendulum exercise (see below) is recommended to reduce pressure on the rotator cuff by widening the space the tendons pass through. You can start this exercise almost immediately. As your rotator cuff tendonitis improves, physical therapy with stretching and muscle-strengthening exercises becomes important. A physical therapist can help you with these exercises, but most of them you can also do on your own. Before exercising, warm up your muscles and tendons in a warm shower or with a heating pad. You may experience some mild soreness with muscle-toning exercises — ice applied to the shoulder should help relieve it — but if you develop sharp or severe pain, stop the exercises for a few days.

Image: Jan-Otto/Getty Images

The Joint Pain Relief Workout: Healing exercises for your shoulders, hips, knees, and ankles

Is joint pain holding you back? Perhaps an achy ankle or sore knee is making it difficult to enjoy a run through your favorite park or even a short walk? Or a throbbing hip or shoulder prevents you from driving a golf ball down the fairway or from performing simple tasks like carrying a bag of groceries into your home? The exercises in this report can help relieve ankle, knee, hip, or shoulder pain, and help you become more active again, which in turn can help you stay independent long into your later years.  

Designed by knowledgeable exercise experts, our workouts are intended to strengthen the muscles that support your joints, increase flexibility in your joints, and improve range of motion. Done regularly, these exercises can ease pain, improve mobility, and help prevent further injury.

The Joint Pain Relief Workout includes four workouts targeting your ankles, hips, knees, and shoulders. You’ll find detailed instructions for each exercise, as well as information on how to adapt each exercise to make it either harder or easier, so you can tailor it to your ability. In addition, the report includes mini-workouts to address wrist and elbow problems, a planning worksheet to help you get started and stay motivated, and answers to common exercise questions.

Prepared by the editors of Harvard Health Publishing in consultation with Lauren E. Elson, M.D., Department of Physical Medicine and Rehabilitation Instructor, Harvard Medical School, and Michele Stanten, Certified Fitness Instructor, American Council on Exercise (2021)

If you haven’t been working out regularly, or even if you have, you may have some questions about getting started on the workouts in this report. Here we answer some common questions.

1. Which workout should I do?

That depends on which joints are bothering you. If it’s an ankle, turn to “Ankle workout”; if it’s your hips, turn to “Hip workout.” What if it’s both? It’s safe to do both routines as long as the problems you’re experiencing are described in the workout introductions. If you have more significant joint problems, or if you have any doubts, see your doctor before you start any workout!

Pair the workout or workouts you choose with the weekly walking program or another choice to get the cardio tune-up your body needs.

2. What if I can’t do all the reps or sets suggested?

Quality is much more important than quantity. While you want to challenge yourself, it’s okay if you can’t do all the recommended reps or sets at the start. Begin by trying to finish a single set of each exercise in the workout, then gradually work up to more as you progress. Within any set, only do as many reps as you can manage while following instructions, maintaining good form, and sticking to the specified tempo. If necessary, try lightening up the weight or resistance to make this possible.

3. How much weight or resistance should I use?

It’s wise to have a selection of light weights (1, 2, and 3 pounds) and resistance tubing or bands (light through medium resistance).

Select the highest weight or level of resistance that allows you to accomplish all of the following:

• maintain good form throughout the exercise
• stick to the specified tempo
• complete the suggested number of reps and sets
• achieve a full and pain-free range of motion.

Wait until you find it easy to meet all four requirements before you increase the weight or resistance for a particular exercise. If it’s difficult to meet any of the four, decrease the weight or resistance.

As you try the exercises, you’ll find some muscle groups are stronger than other groups. Thus, you’ll need to vary the amount of weight or resistance used in the course of your workout.

4. How often should I do the exercises in a workout?

A full workout incorporates warm-ups, muscle strengthening exercises, and stretches. We recommend doing full workouts two to three times a week. Strenuous exercise like strength training causes tiny tears in muscle tissue. The muscles grow stronger as the tears knit up. Always allow at least 48 hours between strength training sessions to give the muscles time to recover. Warm-ups and stretches can be done more often—even daily—to enhance flexibility.

Treatment Rotator cuff injury

WHAT IS A ROTATORIAL (ROTATOR) CUFF AND WHAT IS IT FOR?

Rotational (rotator) cuff of the shoulder – includes the supraspinatus, infraspinatus, small round and subscapularis muscles. These muscles are necessary to stabilize the head of the humerus and prevent it from moving when moving in the joint. In addition, these muscles allow for rotational movements in the shoulder in all directions.

The subscapularis muscle rotates the arm inward, the supraspinatus muscle raises the shoulder and “anchors” it, i. e. presses the head of the humerus into the articular cavity of the scapula when the shoulder is abducted to the side. In this case, the main abduction force is determined by the deltoid muscle, and the supraspinatus muscle works as a commander, directing the efforts of the deltoid muscle. The infraspinatus muscle rotates the shoulder outward, and the small round muscle rotates outward and brings the arm to the body. Damage to at least one of the four muscles leads to a sharp limitation of movement and loss of function of the shoulder joint.

CAUSES OF DAMAGE OR RUPTURE OF THE ROTATOR (ROTATOR) CUFF OF THE SHOULDER:

Rotator cuff injury can result from acute trauma. In this case, patients often describe a specific injury, after which pain appeared and the function of the shoulder was impaired.

In some cases, rupture of the rotator cuff is the result of chronic microtrauma to the muscles. Most often this occurs in persons whose professional activities are associated with frequent elevated position of the hand or throwing movements. For example, athletes in sports such as baseball, tennis, weightlifting and rowing. Constant microtraumatization of the tendons of the rotator cuff when hitting the ball, serving, throwing can lead to micro-ruptures of muscle fibers, the muscles gradually become thinner and over time, even with a minor injury, they can easily tear.

The rotator cuff tendons are prone to overstressing in teachers who write with chalk on a blackboard with their hand up, painters who paint walls, builders, and the like.

In some patients, rupture of the rotator cuff may be due to the development of degenerative-dystrophic changes in the muscles associated with aging, for example, in the elderly or a genetic predisposition.

TYPES OF DAMAGE OR RUPTURES OF THE ROTATOR (ROTATOR) CUFF OF THE SHOULDER:

Due to the cause of the rupture – traumatic or degenerative ruptures. According to the nature of the damage, partial and complete ruptures are distinguished. Partial ruptures do not pass through the entire thickness of the tendon, full ones extend through the entire thickness of the layers of the cuff. Traumatic injuries are divided into fresh, stale and chronic.

SYMPTOMS OF DAMAGE TO THE ROTATOR (ROTATOR) CUFF OF THE SHOULDER:

Signs of damage to the rotator cuff are pain and weakness in arm abduction or external rotation of the shoulder.

Pain intensifies in certain phases of movement, especially when abducting the arm

at an angle of 70 – 120 °.

DIAGNOSTICS OF DAMAGE TO THE ROTATOR CUFF:

Diagnostic tests:

To diagnose damage to the rotator cuff, special tests are used in which the doctor, bringing the patient’s hands to a certain position, evaluates the motor ability of the injured arm, and observes the patient’s reaction to his actions. The most informative tests are for weakness of abduction and weakness of external rotation of the shoulder. With extensive damage to the rotator cuff, symptoms of a falling arm are also characteristic (the patient cannot hold the passively abducted arm) and raising the shoulder girdle when trying to abduct the arm (Leclerc’s symptom).

Ultrasound – diagnostics

MRI – study

X-ray – research

TREATMENT OF A ROTATOR CUFF INJURY:

Treatment of a rotator cuff injury can be conservative or surgical. Conservative treatment is indicated for partial injuries, when there is hope for restoration of function without surgery. Conservative treatment is carried out along with immobilization of the shoulder joint with a special bandage (orthosis), and includes:

physiotherapy, the use of anti-inflammatory and analgesic drugs, with severe pain – blockade with long-acting glucocorticoids. A very good clinical effect is given by intra-articular injections of platelet-rich plasma into the shoulder joint (“growth factors”, PRP).

If the duration of unsuccessful conservative treatment exceeds 2-3 months, it is necessary to raise the question of surgery.

SURGICAL TREATMENT OF DAMAGES TO THE ROTATOR (ROTATOR) CUFF OF THE SHOULDER:

Repairing a torn rotator cuff tendon is a fairly complex operation. Reconstruction of the rotator cuff can be performed both openly, through an incision on the shoulder, and arthroscopically. The disadvantages of open surgery are the need for large, traumatic incisions on the shoulder to provide access to damaged tendons, which carries a high risk of side effects, and a long recovery after surgery.

In our Medical Center, surgical treatment of rotator cuff injury is performed in a modern way, without incision of the joint – under arthroscopic control. Instead of an incision, local mini-punctures are performed, into one of which an arthroscope with a video camera is inserted, and into the other, instruments for the operation. An enlarged image from the video camera is transmitted to the video monitor, which allows the doctor to examine in detail all the structures of the joint and identify the location of the damage.

The essence of the arthroscopic operation is that the rupture is sutured, and if the tendon is torn off from the place of fixation, then a suture is performed using special “anchor” fixators.

At the first stage of the operation, the joint is cleaned – the removal of all non-viable, degenerative – altered tissues of the rotator cuff. Then the area of ​​the humerus where the rotator cuff was torn or torn off is cleared of soft tissue remnants so that the tendon grows better to it. Usually, 2-3 anchors are required to fix a torn tendon. The latch consists of an anchor and threads. The anchor is attached to the bone, and the tendon is stitched with threads.

The choice of a specific type of anchor is made by the operating surgeon, but in general, the patient should also be informed about which anchor is planned to be used in his case. We recommend using clamps from world-famous companies that have proven themselves for a long time.

REHABILITATION AFTER SHOULDER ARTHROSCOPY:

Properly performed surgery allows you to quickly start active rehabilitation, to prevent the development of complications and optimize the recovery time.

After shoulder arthroscopy, the arm is immobilized in the abduction position for several weeks using a special splint. Such immobilization reduces tendon tension and reduces the risk of re-rupture, creates favorable conditions for better healing of the tendon. The duration of immobilization is determined by the surgeon who performed the operation, since only he can assess the condition of the tendons and the strength of the suture.

Already from the first weeks after shoulder arthroscopy, patients are recommended to perform special exercises aimed at developing movements in the shoulder joint. However, their intensity and sequence should be selected by the operating doctor and an experienced rehabilitation specialist.

In our Medical Center, patients after shoulder arthroscopy are offered a whole range of rehabilitation measures. The rehabilitation program is selected individually and includes:

Special exercises and exercise therapy by rehabilitators of our Medical Center using the kinesiotherapy method. Exercises are aimed at improving the range of motion in the joint, preventing the development of contractures, increasing strength and endurance in the muscles of the shoulder girdle. Exercises are selected on an individual basis and performed on professional equipment in the rehabilitation room, under the supervision of experienced instructors – rehabilitologists. Some of the exercises are signed for the patient to carry out at home.

Physiotherapy on professional equipment from BTL: magnetotherapy, ultrasound therapy with the introduction of drugs, electrotherapy – reduce pain and swelling in the operated shoulder, prevent the formation of adhesions and scars, promote better healing, restore muscle tone.

TRUST THE CARE OF YOUR HEALTH TO REAL PROFESSIONALS!

Rotator cuff repair

Rotator cuff repair.

A ruptured rotator cuff is a serious injury with limited upper limb function. Usually complicated by subluxation of the head of the humerus.

Types of tendon rupture:
Depending on which ligaments are damaged, there are:
– Torn rotator cuff – it consists of the tendons of the subscapularis, teres minor, supraspinatus and infraspinatus muscles. All of them are interconnected and with the joint capsule, provide its mobility and integrity.
– Rupture of the tendon of the biceps muscle of the shoulder
• long head
• short head
Depending on the degree of damage, they distinguish:
– Complete rupture of the ligament – in this case, all fibers of the ligament are damaged and it is torn in two.
– Partial rupture of the ligament – not all fibers are damaged, but only part of them. This condition is called a “sprain” of the ligament.

The causes of damage to the rotator cuff can be different:
– Acute injury. Most often, this fall on the shoulder or elbow joint, as well as a blow to the shoulder joint area, can be accompanied by damage to the tendons.
– Chronic traumatization of connective tissue structures or muscle fibers against the background of systematic loads and performance of the same type of hand movements. This reason is most often realized in athletes who are engaged in shot put, javelin throwing, rowing, weightlifting, tennis. Also, premature wear of the cuff occurs in people whose professions are associated with the same type of hand movements raised up: teachers writing with chalk, painters, plasterers.
– Age-related changes. Age-related changes can lead to rupture of the rotator cuff. Over time, the tendons become weaker and more easily injured.
– Congenital or acquired change in the anatomical ratio of various structures of the shoulder joint, leading to an increase in the load on the ligamentous apparatus, capsule and muscles.
– Decrease in the strength of the ligamentous apparatus, which is of a hereditary origin, realized at the genetic level (decrease in the number of collagen fibers in the connective tissue).

Symptoms of rotator cuff injuries depend on the degree of tear (complete or partial). With a partial tear, the patient can move the shoulder through the pain and often not fully. If the tendon is completely torn, a certain movement is almost impossible, and attempts to move it are painful. For example, if the tendon of the supraspinatus muscle is damaged, the abduction of the arm to the side suffers, while the subscapularis – its introduction to the opposite scapula. The patient complains of the inability to sleep on the affected shoulder. With an acute injury, severe pain occurs in the shoulder joint.

In a chronic process, pain at first occurs occasionally, associated with raising the arm up. Over time, this unpleasant symptom appears more often, intensifies at night. As a result, the pain becomes constant, and the patient cannot perform the usual hand movements: comb or take off clothes without outside help. In the absence of proper timely treatment, arthrosis of the shoulder joint is formed.

Diagnostics

Reliable determination of the localization, as well as the severity of the violation of the anatomical integrity of the muscles, ligaments and tendons of the joint, is carried out with the help of additional objective diagnostics.
X-ray examination is mandatory, with the help of which it is possible to detect a sign of tendon rupture – subchondral sclerosis. It is formed due to friction of the head of the humerus against the lower part of the acromion.
If the diagnosis is in doubt and to clarify the nature and severity of the injury, ultrasound or MRI is performed, which allows examination of soft tissues, and arthroscopy can also be performed arthroscopy.

The choice of a diagnostic examination method is carried out by a doctor on the basis of a clinical examination (includes a survey, examination of the patient, performance of diagnostic tests), as well as the technical capabilities of the medical institution, providing it with the necessary equipment to perform diagnostic procedures.

Treatment:
Conservative treatment.

If the damage is not significant (partial damage), you will be offered conservative treatment.
Treatment involves ultrasound-guided injection of platelet-rich plasma into the site of injury. If necessary, radiofrequency ablation of the suprascapular and axillary nerves is performed to eliminate pain and facilitate the performance of special exercises, as well as during the recovery period, it is necessary to carry out blockades.

Surgical treatment.
With a complete rupture, conservative treatment is futile. Torn ligaments will not heal on their own. To repair the rotator cuff, the operation can be performed by open access or with the help of arthroscopy.

•During a surgical operation (open approach), reconstruction of the rotator cuff in our clinic is performed through a small, 5 cm long incision on the skin. Quite often, 2-3 so-called “anchor fixators” are required to fix a torn tendon. This retainer consists of an anchor and threads. The anchor is attached to the bone, and the tendon is stitched with threads. The choice of a specific type of anchor fixator is carried out by the operating orthopedic traumatologist, however, the patient is informed in detail about which fixator is planned to be used in his case. At the Anesta clinic, we use fixators from world-famous companies that have long established themselves: HEALIX ™ by DePuyMitek (a division of Johnson & Johnson) and TWINFIX ™ by Smith & Nephew.

• During arthroscopy, 4-5 micro incisions will be made around the joint. Arthroscopic surgery begins with the removal of “non-viable” tissues (scar tissue) and bone growths from the area of ​​the shoulder joint. Next, the damaged tendons are sutured under camera control. If there is a separation of the tendon from the bone, the integrity of the anatomical structure is restored using anchor fixators.

Recovery period.
The patient walks for 3 months in a special fixator, after which it is necessary to restore movement in the shoulder.