ROTATOR CUFF TENDINITIS/PARTIAL TEAR        KANDILNOTES                                                                                        

INTRODUCTION

  • Rotator cuff tendinitis and partial tearing are common shoulder pathologies

  • The pathology resulting from shoulder impingement involves three important structures:

  1. Rotator cuff tendinitis

  2. Subacromial bursa

  3. Acromion bone

  • Shoulder impingement can lead to the structures between the proximal humerus and acromion (subacromial bursa and rotator cuff tendon) getting pinched, causing inflammation and rotator cuff tendinitis

  • The repetitive rubbing of the rotator cuff tendon and subacromial bursa leads to rotator cuff tendinitis and subacromial bursitis. Both of these processes are very painful and are worse with overhead activities

CAUSES

  • Rotator cuff tendinitis has numerous causes

  • Repetitive overhead activities or longstanding impingement

  • Degenerative in older patients

  • Repetitive overhead activities can predispose to shoulder impingement, subacromial bursitis, and rotator cuff tendinitis

  • Having a downsloping acromion is a predisposing factor to developing shoulder impingement

  • Weak or deconditioned rotator cuff muscles lead to excessive shoulder motion, causing the shoulder to rub against the acromion and irritate the subacromial bursa and rotator cuff tendon

 

SIGNS AND SYMPTOMS

  • Patients with rotator cuff tendinitis have shoulder pain that is worse with overhead activities

  • Patient with rotator cuff tendinitis often have pain at night and pain when sleeping on affected side

TREATMENT

  • A course of physical therapy or a home exercise program is the mainstay of treatment for shoulder rotator cuff tendinitis and partial tearing. The idea is that strengthening the rotator cuff tendons will prevent the shoulder from excessively moving thereby decreasing the likelihood of the shoulder rubbing against the acromion 

  • Anti-inflammatories such as ibuprofen or meloxicam may help decrease inflammation from the rotator cuff tendinitis and subacromial bursitis

  • A corticosteroid injection in the subacromial space can locally decrease the inflammation and pain

  • Orthobiologics such as platelet rich plasma (PRP) can be considered for rotator cuff tendinitis that is refractory to conservative management. The theory behind this is that PRP can deliver growth factors to the degenerative rotator cuff tendons which have poor blood supply and healing potential. This may result in healing and decreased pain

  • Surgery can be considered if patients fail at least 6 months of conservative management. Surgery consists of an arthroscopic shoulder surgery called a subacromial decompression. The acromial bone is smoothened while the inflamed bursal tissue is debrided and removed.

  • If the partial rotator cuff tear is greater than 50% tendon width, surgery is composed of an arthroscopic rotator cuff repair with multiple small portal incisions. 

  • Keeping the shoulder joint stable by maintaining strong rotator cuff tendons is the best way to prevent shoulder impingement/rotator cuff tendinitis

  • Avoiding repetitive overhead activities may decrease the chance of developing rotator cuff tendinitis/partial tear

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