Rotator Cuff Tendinopathy

What is Rotator Cuff Tendinopathy?

Rotator cuff tendinopathy, also known as shoulder tendinopathy, encompasses a range of shoulder tendon injuries. This condition specifically targets the rotator cuff tendons of the shoulder. When these tendons suffer injury, we refer to it as rotator cuff tendinopathy. It can manifest in various forms, such as supraspinatus, subscapularis, or infraspinatus tendinopathy. Bicipital tendinopathy, although not a rotator cuff tendon injury, often accompanies these conditions. Calcific tendinopathy, where calcium deposits form within the tendon, is another variant.

Demystifying Shoulder Tendinitis

Shoulder tendinitis signifies inflammation in the rotator cuff tendons. Common in the acute phase of injury, it’s a natural part of the healing process. However, contrary to previous beliefs, tendinitis only occurs in a minority of shoulder tendinopathy cases.

What Causes Shoulder Tendinopathy?

Repeated microtrauma, rather than a single incident, typically causes shoulder tendinopathy. This repeated trauma can lead to shoulder impingement, where the rotator cuff tendon rubs against the acromion bone, an abnormal occurrence during normal shoulder function. Shoulder bursitis often accompanies rotator cuff tendinopathy or impingement.

Identifying the Symptoms

Common symptoms of shoulder tendinopathy include shoulder clicking, pain at shoulder height, discomfort when lying on the affected side, pain during certain movements, and in severe cases, constant shoulder pain.

Diagnosis and Prognosis

Physiotherapists and doctors diagnose shoulder tendinopathy through symptom history and clinical tests, with ultrasound scans being a preferred diagnostic tool. While X-rays don’t reveal tendinopathy, they can identify long-term bone changes impacting the condition. Ultrasounds will diagnose shoulder bursitis, rotator cuff tendinitis, rotator cuff tears or dynamic shoulder impingements. MRIs are less definitive.

If untreated or neglected, shoulder tendinopathy can worsen, leading to more severe issues like rotator cuff tears, necessitating surgery. However, with proper treatment, most cases are reversible.

Rotator Cuff Tendinopathy Treatment

Rotator cuff tendinopathy affects many, but its treatment varies per individual. Rehabilitation hinges on thorough assessment and addressing joint issues. Research pinpoints seven key stages for effective rehabilitation and recurrence prevention.

Phase 1: Early Injury Protection

Immediate steps include Rest, Ice, and Support. Limiting movement in painful positions is crucial. Ice application reduces pain and swelling. While some may opt for anti-inflammatory medication, natural alternatives like arnica are also beneficial. Support through slings or taping, guided by a physiotherapist, provides relief. During this phase, physiotherapists employ various pain-relief techniques, including joint mobilisations, massage, acupuncture, or dry needling.

Phase 2: Regaining Full Range of Motion

Protecting injured tendons is vital for healing. This phase focuses on remoulding tendon tissue, aided by joint mobilisations, massage, stretches, and light exercises. Achieving full range of motion is a sign of recovery, and a physiotherapist will guide these exercises.

Phase 3: Restoring Scapular Control

The shoulder blade, or scapula, plays a fundamental role in arm movements. Poor scapulohumeral rhythm is a common cause of rotator cuff impingement. A physiotherapist’s role in correcting this and providing stabilisation exercises is crucial.

Phase 4: Enhancing Neck and Upper Back Function

Neck and thoracic spine health are crucial for shoulder function. Dysfunctions in these areas can lead to pain and weakness in the shoulder. Addressing these with appropriate treatments can significantly improve shoulder movement and prevent future injuries.

Phase 5: Strengthening the Rotator Cuff

The rotator cuff is key for shoulder stability. Strengthening these muscles, especially after initial healing, is crucial. Physiotherapists tailor exercises to suit the specific injury and any secondary conditions like bursitis.

Phase 6: High Speed, Power, Proprioception & Agility Training

For sports-related tendinopathies, exercises that focus on speed, agility, proprioception, and power are vital. This training prepares for a safe return to sport, addressing the demands of specific activities.

Phase 7: Returning to Sport or Work

Tailored exercises and training regimens are essential for a safe return to sport or work. Technique assessments in sports and discussions with healthcare providers for work-related injuries are part of this phase.

Conclusion: Seeking Professional Guidance

Tendinopathy, specifically rotator cuff tendinopathy, requires a customised approach. While this article provides an overview, seeking personalised advice from a shoulder physiotherapist is crucial for effective treatment and prevention of future injuries.