Rotator Cuff Tendinopathy

What is it?

The rotator cuff refers to a group of four small muscle groups which run from the shoulder blade to the top of the arm bone. They support and move the shoulder joint. The rotator cuff muscles attach to the arm bone by tendons. Rotator cuff tendinopathy refers to inflammation and swelling within one or more of these tendons.

How does it happen?

Rotator cuff tendinopathy results from overuse or injury to the rotator cuff tendon. The most commonly involved tendon in that of the supraspinatus muscle. This muscle helps to raise the arm into the air. Its tendon passes through a small space between the top of the arm bone and the point of the shoulder. In this space the tendon is susceptible to ‘wear and tear’. Repetitive use of the supraspinatus muscle and, therefore, the supraspinatus tendon can rub the tendon against the edges of the bony space resulting in microscopic tears within the substance of the tendon.

How does it feel?

Rotator cuff tendinopathy results in pain in the top of the upper arm. This is usually felt when you try to lift your arm into the air and typically develops gradually. Initially, the tendon may only be painful following exercise. For example, it may be first felt on rising the day following participation. Associated with the pain may be stiffness or tightness of the shoulder. Typically, these initial signs of the rotator cuff tendinopathy are ignored, as they disappear quickly with the use of the arm or applying heat (i.e. A hot shower) over the shoulder. However, you continue to participate, the tendinopathy progresses and the pain within the tendon becomes more intense and more frequent. For example, it may begin to be present during participation. In earlier stages, this pain during participation may initially disappear as you warm up, only to return when you cool down. However, as you continue to participate, the tendinopathy worsens and your pain may begin to be present for longer periods during participation until it is present each time you lift your arm. This may interfere with your performance.

What should you do?

Rotator cuff tendinopathy generally does not get better on it own if the cause is not addressed and you continue to participate. If you have or suspect you have rotator cuff tendinopathy, you should consult your nearest sports physiotherapist. In the meantime, you can begin initial treatment. This should consist of icing following participation. Icing may consist of crushed ice wrapped in a moist towel applied to the sore area for 15-20 mins.

What shouldn’t you do?

If you have or suspect you haver rotator cuff tendinopathy, you shouldn’t ignore the problem. Your pain may get better as you exercise; however the exercise you are doing may be interfering with the healing process and causing further damage. This can lead to your injury getting worse such that your pain does not ‘warm up’ and you feel it throughout participation. If this occurs, your recovery may be prolonged and it may take a number of weeks or months for you to return to full participation.

Could there be any long-term effects?

Rotator cuff tendinopathy does not produce any long term effects as long as it is properly diagnosed and appropriately treated. If not, it can lead to prolonged pain in the upper arm and a prolonged lay-off from participation.

Management

The assistance of a sports physiotherapist is important in the treatment of rotator cuff tendinopathy. Initially, they can assist in diagnosing the problem and its severity. This may require the use of imaging techniques such as ultrasound or MRI. From this, the sports physiotherapist will be able to determine an appropriate treatment plan. This may involve activity modification, soft tissue treatment such as massage and stretching, and the progression through a series of specific strengthening exercises. The sports physiotherapist will also be able to assess and determine why you developed rotator cuff tendinopathy and address this during your recovery to prevent re-occurrence when you return to full activity.

Brukner & Khan (2012) Clinical Sports Medicine.