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Rotator Cuff Tendonitis

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Other Names

  • Subacromial Bursitis
  • Subacromial Impingement Syndrome
  • Rotator Cuff Tendinitis
  • Rotator Cuff Tendinopathy
  • Shoulder Impingement Syndrome
  • Partial Rotator Cuff tear

Background

  • This page describes tendinopathies of the Rotator Cuff (RC)
  • Because it is clinically indistinguishable from subacromial bursitis and impingement syndrome, those entities are also discussed here
  • Additionally, partial rotator cuff tears also land on this spectrum of disease but are generally discussed on the Rotator Cuff Tear page

Epidemiology

  • Most common cause of shoulder pain, accounting for up to 50% of cases[1]
  • Incidence ranges from 0.3% to 5.5%[2]
  • Prevalence from 0.5% to 7.4%
  • Up to 14% of the working population may have symptomatic RC tendinopathy[3]

Pathophysiology

Etiology

  • Extrinsic[4]
  • Intrinsic
    • Alterations in tendon vascularity, physiology or mechanical properties have been proposed
    • Age-related degeneration
    • History of trauma

Pathoanatomy

Associated Injuries


Risk Factors

  • Sports
    • Overhead athletes
    • Throwing sports
  • Anatomic
    • Type III or II acromions
  • Previous shoulder injury or trauma
  • Increased age
  • Occupational[5]
    • Overhead or above shoulder work
    • House painting
    • Carpentry

Differential Diagnosis


Clinical Features

  • History
    • Patients will most commonly report atraumatic shoulder pain
    • Location is typically lateral or anterior, but can be nonspecific
    • Worse at night
    • Worse with overhead activity
    • Often a history of repetitive overhead activity, less commonly acute
    • Other symptoms can include clicking, popping
  • Physical: Physical Exam Shoulder
    • Observe for any asymmetry in musculature of the scapula
    • Tenderness to rotator cuff insertion along proximal humerus
  • Special Tests
    • Rent Test: Can demonstrate defect with passive extension
    • Hawkins Test: Shoulder and elbow flexed to 90°, internally rotated
    • Neers Test: Shoulder flexed to 90°, thumb pointed towards floor and flexed against resistance
  • Supraspinatus
    • Drop Arm Test: Arm is passively abducted and slowly allowed to return to a neutral position
    • Painful Arc Test: Painful active abduction and adduction
    • Jobes Test: Similar to empty can test
    • Empty Can Test: Shoulder flexed to 90°, thumb pointed towards floor and flexed against resistance
    • Full Can Test: Similar to empty can but with external rotation
  • Infraspinatus/ Teres Minor
  • Subscapularis

Evaluation

Radiographs

MRI

  • Useful in cases of suspected tear or unclear diagnosis

Classification

Neer Classification

  • Stage I: edema and hemorrhage within the rotator cuff[6]
  • Stage II: progression to fibrosis and thickening of the subacromial bursa and chronic supraspinatus tendinitis
  • Stage III: partial or full-thickness tears of the rotator cuff and biceps tendon lesions

Management

  • 46% of people improve with conservative therapy at 6 months, 77% at 18 months[7]

Nonoperative

Operative

  • Indications
    • Failure of conservative treatment for a minimum of 6 months
  • Technique
    • Acromioplasty (sometimes referred to as subacromial decompression)
      • Low-to-moderate quality evidence acromioplasty is no more effective than exercises for the treatment of RC tendinopathy[10]
    • Bursectomy
    • Radiofrequency (RF)-based microtenotomy

Rehab and Return to Play

Rehabilitation

  • Needs to be updated

Return to Play

  • Non-surgical
    • After a period of relative rest, graduated RTP with throwing program
  • Surgical
    • Longer recovery period at discretion of surgeon
    • Typically 6-12 months
  • After surgical repair, overall rate of return found to be 84.7%[11]
    • Overall athletes: 65.9% returned to equivalent level of play
    • Professional athletes: 49.9% returned to same level of play

Complications

  • Chronic pain
  • Inability to return to sport
  • Diminished strength, range of motion

See Also


References

  1. Tekavec E, Joud A, Rittner R, Mikoczy Z, Nordander C, Petersson IF, et al. Population-based consultation patterns in patients with shoulder pain diagnoses. BMC Musculoskelet Disord 2012; 13: 238.
  2. Littlewood, Chris, Stephen May, and Stephen Walters. "Epidemiology of rotator cuff tendinopathy: a systematic review." Shoulder & Elbow 5.4 (2013): 256-265.
  3. Adebajo A, Hazleman B. Soft tissue shoulder lesions in the African. Br J Rheumatol 1992; 31:275–6.
  4. Seitz AL, McClure PW, Finucane S, Boardman ND III, Michener LA (2011) Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both? Clin Biomech 26(1):1–12
  5. 7. Bodin J, Ha C, Le Manac’h A, et al. Risk factors for incidence of rotator cuff syndrome in a large working population. Scand J Environ Health 2012; 38:436–46.
  6. 35. Neer, C. S., II. Impingement lesions. Clin. Orthop. 173:70-77, 1983.
  7. Bartolozzi, A., D. Andreychik, and S. Ahmad. Determinants of outcome in the treatment of rotator cuff disease. Clin. Orthop. 308:90-97, 1994.
  8. Boudreault, Jennifer, et al. "The efficacy of oral non-steroidal anti-inflammatory drugs for rotator cuff tendinopathy: a systematic review and meta-analysis." Journal of rehabilitation medicine 46.4 (2014): 294-306.
  9. 9.0 9.1 9.2 9.3 Toliopoulos, Panagiota, et al. "Efficacy of surgery for rotator cuff tendinopathy: a systematic review." Clinical Rheumatology 33.10 (2014): 1373-1383.
  10. Toliopoulos, Panagiota, et al. "Efficacy of surgery for rotator cuff tendinopathy: a systematic review." Clinical Rheumatology 33.10 (2014): 1373-1383.
  11. Klouche S, Lefevre N, Herman S, Gerometta A, Bohu Y. Return to sport after rotator cuff tear repair: a systematic review and metaanalysis. Am J Sports Med. 2016;44(7):1877–87. This recent analysis details the overall return-to-play in both professional and competitive athletes.
Created by:
John Kiel on 11 June 2019 01:34:06
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Last edited:
20 August 2021 08:14:36
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