ROTATOR CUFF TENDINITIS/TEAR

Rotator cuff diseases include inflammation (tendinitis) and possibly a partial- or full-thickness tear of the tendon. This causes marked pain in the shoulder region, which may worsen at night or with activities in which the arms are held over the head. Rotator cuff problems are caused by cumulative trauma throughout one's lifetime. It is believed to be partially caused by impingement of the tendon on a bone spur within the shoulder. Rotator cuff tendinitis or tear is fairly common. It is usually detected by means of placing the shoulder through ranges of motion that reproduce the pain. The diagnosis is generally made by means of history and physical examination. Magnetic resonance imaging (MRI) is helpful when a tear is suspected. Rotator cuff tendinitis or tear can be managed to the point that pain can usually be completely alleviated.

Signs and symptoms of rotator cuff tendinitis and possible tear include pain in the shoulder that worsens with activities such as lying down to sleep at night or working with one's arms over one's head. The tendinitis not only causes pain in the shoulder region but also can eventually lead to a tear in the rotator cuff tendon itself. When that happens, the shoulder becomes much weaker, and it becomes quite difficult to perform any activities above your head.

Rotator cuff tendinitis generally can be managed successfully with nonsurgical methods. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help not only to control inflammation but also to relieve pain. Exercise, specifically physical therapy focused on rotator cuff rehabilitation to strengthen the internal and external rotator tendons of the shoulder can make a difference in the overall pain (Fig 2). Surgical decompression or possible repair of the torn tendon is considered when physical therapy does not make a difference or should the tendon actually sustain a tear. Surgical treatment may have complications, and you should discuss them thoroughly with your physician before you undergo this form of treatment.

• Take your medications as prescribed.
• Perform your exercises as directed.

• Avoid addictive pain medications as long-term therapy for rotator cuff tendinitis or tear.
• Avoid activities that necessitate using your hands above your head.
• Do not attempt to strengthen the shoulder with push-ups. This has not been found to make a difference and may worsen the pain.

• If pain is severe enough to prevent you from sleeping satisfactorily at night and is not controlled with over-the-counter medications.

http://www.sechrest.com/mmg/shoulder/cufftear.html

 

Rupture of the rotator cuff (arrow). (From Mercier LR: Practical Orthopedics, ed 4, St. Louis, Mosby—Year Book, 1995. Used by permission.)

 

Shoulder exercises. A, Pendulum exercises. B, Wall-climbing exercise. C, Pulley exercises. The normal arm assists in the elevation of the stiffened arm. D, Exercise for restoring internal rotation. E, Exercise for restoring external rotation. Each exercise should be performed hourly or at least four times a day. Applying moist heat before the exercise may be helpful. In addition, activities that aggravate the pain, such as overhead work, should be avoided. For sitting work, a chair that supports the arms and shoulders should be used, and the patient should sit as close to the working surface as possible. (From Mercier LR: Practical Orthopedics, ed 4, St. Louis, Mosby—Year Book, 1995. Used by permission.)

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