Rotator Cuff Tendinitis / Impingement / Bursitis

Rotator Cuff Tendinitis is an overuse condition that causes pain and disability in the shoulder and upper arm. It is often referred to as impingement or bursitis. All three names refer to the same condition, caused by using the arm and shoulder in tasks that are repetitive and often involve moving the arm above the level of the shoulder.

Causes and Symptoms

Common athletic activities that produce this condition are racquet sports, swimming, throwing, weight lifting and calf roping. As the athlete increases activity levels too quickly or works out for long periods of time, the muscle-tendon groups may become inflamed. Pain, tenderness and inability to perform shoulder movements result.

Other activities such as painting, driving or carpentry also may cause and/or aggravate the condition. Tendinitis often brings pain with such activities as combing your hair, putting on a jacket, tucking in your shirt, or sleeping on the shoulder or with your arm over your head. The condition may be acutely painful, or it can be chronic with a dull pain lasting months.

Diagnosis

There are several components to diagnosing rotator cuff tendinitis:

1. Your physician will take a careful history.

2. Specific tests on physical examination.

3. X-rays may be helpful to detect bone spurs.

4. Occasionally, an injection of xylocaine into the bursa adjacent to the cuff will alleviate pain, and helps to confirm the diagnosis.

5. In complicated cases, an MRI (magnetic resonance imaging) may be ordered to carefully evaluate the cuff tendons for tears or degeneration.

Treatment

Treatment is usually non-surgical. The goals of the treatment program are first to lessen the inflammation and then stretch and strengthen the rotator cuff muscles. The inflammation can usually be controlled with rest, ice and oral medication (anti-inflammatory).

It is best to reduce or stop the offending activity. This may mean stopping or reducing yardage in a swimming program or only volleying with no overhead serves in tennis. You may also need to modify or stop certain work activities (i.e., use of a computer mouse, painting, etc.) for a period of time.

After the inflammation has been controlled, your physician will most likely prescribe a stretching and strengthening program. It is important that you stay with the program to achieve lasting results. At the beginning of the strengthening program it may help to ice your shoulder after the exercises. The stretching exercises are done before the strength exercises to warm up and stretch out the cuff muscles.

Perform the following exercises at least four times a week, preferably daily, with occasional days of rest.

Stretch 1 Bring hand of affected arm to opposite shoulder. Pull shoulder forward slightly. You should experience a slight stretch in the affected shoulder.

Exercise 1 With the arm in an “empty can” (thumb down) position, and at a 45 degree angle to the body, raise the extended arm to 45 degrees or as pain allows.

Stretch 2 Place affected arm up and over head, with hand resting on back of (or extended toward) opposite shoulder. Slowly stretch bent elbow back.

Stretch 3 Bring hand of affected arm to opposite shoulder. Pull shoulder forward slightly. You should experience a slight stretch in the affected shoulder.

Exercise 3 Lie on a table with elbow on the edge and hand hanging over, with weight in hand. Raise the weight parallel with the ground to the level of the table or your head (keep back flat and do not arch). Lift elbow towards the ceiling and squeeze the shoulder blades together. Start with low weight and work on your technique. Do not swing the weight up. Remember: slow and controlled. Increase weight as strength builds.

Note: You may feel some discomfort. But you should not feel pain. These methods may work by themselves or may require the additional use of physical therapy (ultrasound, electrical stimulation, etc.). Surgical solutions to the problem are usually considered if home care and/or structured therapy for the problem is unsuccessful.

Prevention
It is important to moderate training sessions and take adequate periods of rest between training sessions to help in the prevention of tendinitis. Warming up, stretching and strengthening are also good components of prevention. Early attention to soreness in the shoulder and upper arm during training or after a session may prevent a chronic problem. Treatment of shoulder symptoms should be started as soon as noticed.

This information is provided by Orthopaedic Center of the Rockies as basic information about a specific orthopaedic topic. It is not intended as a personal reply to your specific questions or concerns. For more information, please contact your physician or a physician at Orthopaedic Center of the Rockies, (970) 493-0112 or 1-800-722-7441.

© Orthopaedic Center of the Rockies 1999