Rotator Cuff Problems and Tendonitis

The rotator cuff is a group of muscles that supports the arm and the shoulder joints. They connect the bone of the upper arm (the humerus) with the shoulder blade (the scapula). These consist of four muscles known as; the supraspinatus, the infraspinatus, the teres minor and the subscapularis muscle. The muscles originate from the scapula and attach to the humerus by means of tendons and assist in the movement of the arm and the stabilization of the shoulder joints. Rotator Cuff Tendonitis (also known as impingement syndrome) occurs when these muscles and tendons become inflamed or irritated.

Causes of Rotator Cuff Tendonitis

The shoulder joint type is known as a Synovial Joint, a ball and socket joint, allowing for great freedom of movement. Rotator Cuff Tendonitis or simply Tendonitis can occur when muscles and tendons of the rotator cuff become torn, inflamed , or irritated. Major causes of tendonitis include:

  • Inflammation of the protective sheath that surrounds the tendon – The protective sheath of the tendon (the synovial) produces a liquid (the synovial fluid) that keeps the tendon lubricated. Malfunction of this sheath due to tendon injury may result and cause the sheath not to produce or in insufficient quantity the synovial fluid causing the inflammation or swelling of the sheath.
    • Tendon rupture – The tendon can often support forces 5 times the body weight and at occasions can snap or rupture. Reasons for rupture of the tendon include the use of steroids, certain diseases (gout, hyperparathyroidism), direct trauma, aging, extensive and repetitive use by practicing some sort of sport or other activities.
    • Deterioration of the tendon – The degeneration of the tendon without any apparent inflammation can result due to overuse or age.
    • Inflammation of the tendon – There are a variety of causes resulting in the inflammation of the tendon such as: stress on the tendon, direct trauma, some types of antimicrobial drugs can also cause inflammation, inflammation due to certain types of diseases, and anatomical causes referring how they are actually built.

Most of these conditions are common among athletes and particularly in certain types of sports where there is repetitive and forceful use of the rotator cuff muscle (swimmers, tennis players, basketball players etc.) At occasions it can also be the result from activities work related that requires working with the arm overhead like painting, carpentry, etc. Sleeping on the same arm each night may also cause inflammation of the tendon etc.

Rotator Cuff Tendonitis Symptoms

  • The symptom commonly suggesting a problem with the rotator cuff muscles or tendons is associated with pain near and around the shoulder accompanied with pain during movement of the shoulder for different activities particularly when lifting your arm. Diagnoses of rotator cuff tendonitis would involve describing the type of pain being felt on the shoulder, an x-ray may be recommended as well as ultrasound scan or MRI scan. Often redness or swelling can be seen on the shoulder.
    A drop arm test can be conducted by the doctor consisting of raising your arm 90 degrees and asking you to hold the position for a few minutes
    • X-ray indicate whether there is a dislocation of the humerus
    • The MRI scan assesses the integrity of the rotator cuff
    The pain can come gradually in the case of tendonipathy or it can be sudden and excruciating due to tear because of accident.
    Treatment of Rotator Cuff Injury
    The treatment for tendonitis will largely depend on the type of injury and its severity. In general, beside seeking medical attention , the treatment would involve following the RICE (rest, ice, compression, elevation) principal for home therapy. Depending on the severity, the treatment may or may not involve surgery.
    • Non surgery therapy – Following the RICE principal and adequate medical attention. The doctor could recommend the use of brace or splint to immobilize the rotator cuff so that it can rest. Swelling can be reduced with the application of heat or cold. Some other non surgical therapy include massage, stretching the affected area, Transcutaneous electrical nerve stimulation (TENS), and ultrasound. Medication can also sometimes be prescribed particularly for sheath inflammation which are non-steroidal anti-inflammatory drugs, antibiotics when there is an infection.
    • Surgical intervention – A tear of less than 50% can be repaired by what is known as arthroscopical surgery whereby dead tissues are removed by means of a small incision. In other cases surgical intervention can be undertaken to repair a torn tendon. In most cases, surgery is the preferred choice when a tear is the result of a recent injury, there is a complete and large rotator cuff tear.

Rotator Cuff Tendonitis Prevention
To avoid Tendonitis it is essential to understand the anatomy and biomechanics of the shoulder and to use the proper methods of doing certain activities or exercise. Athlete and those who regularly exercise should not also neglect the rotator cuff muscles and concentrate only on muscles such as the triceps, the deltoid or the pectoralis major. This could cause imbalances that could result in impingement syndrome. Another things to take into consideration is not to push your muscles too hard and be attentive as to how the body reacts for different activities.
Reference:
https://www.nlm.nih.gov/medlineplus/ency/article/007207.htm

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