Jump to content
We need you! See something you could improve? Make an edit and help improve WikSM for everyone.

Rotator Cuff Tendonitis

From WikiSM
(Redirected from Subacromial Impingement)

Other Names

  • Rotator Cuff Disease
  • 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

History

  • Descriptions date back to the late 19th century (need citatoin)

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]

Introduction

Musculoskeletal anatomy of the shoulder and range of motion created by the rotator cuff muscles[4]
(A) a healthy subacromial bursa and (B) an irritated bursa suggestive of subacromial impingement[5]

General

  • Rotator cuff disease is characterized by a tendinopathy of 1 or more of the 4 rotator cuff muscles
  • Represent a spectrum of disease from acute, self limited pain to chronic tendinopathies
  • The diagnosis is primarily clinical and imaging helps exclude other pathology
  • Most patients will do well with conservative management
  • See also: Tendinopathies Main

Etiology

  • Extrinsic[6]
  • Intrinsic
    • Alterations in tendon vascularity, physiology or mechanical properties have been proposed
    • Age-related degeneration
    • History of trauma

Terminology

  • Rotator Cuff Disease: non specific description of pathology to the rotator cuff
  • Subacromial Bursitis: inflammation of the subacromial bursa
  • Subacromial Impinagement Syndrome: the supraspaintus/subacromial bursa are impinged between the humeral head and acromion during shoulder movement
  • Rotator Cuff Tendonitis: acute, inflammatory response of one of the tendons
  • Rotator Cuff Tendinopathy: chronic, degenerative changes of one or more of the tendons

Anatomy of the Rotator Cuff Muscles

Associated Conditions

Risk Factors

  • Sports
    • Overhead athletes
    • Throwing sports
  • Anatomic
    • Type III or II acromions
  • Previous shoulder injury or trauma
  • Increased age
  • Occupational[7]
    • Overhead or above shoulder work
    • House painting
    • Carpentry

Differential Diagnosis

Differential Diagnosis Shoulder Pain

Clinical Features

Clinical tests for the evaluation of rotator cuff disease[4]
Lag tests in rotator cuff disease. A) Drop Arm Test, B) Hornblowers Sign, C) External Rotation Lag Sign, D) Lift Off Test[8]

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
  • Yocums Test: Place hand of affected arm on opposite shoulder, elevate arm

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
  • 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

Extensive osteodegenerative changes involving glenohumeral joint in the form of larger periarticular osteophytosis and fraying of bursal fibers of supraspinatus tendon. Large volume clear fluid seen in subdeltoid bursa communicating with subacromial bursa.[9]
(a) Longitudinal and (b) transverse US scans of a normal rotator cuff (RC) of right shoulder. (c) Longitudinal and (d) transverse US scans of a calcium (Ca) deposit in a rotator cuff (supraspinatus tendon) of the left shoulder with hyperechoic superior contour and posterior acoustic shadow (solid arrows). Note the focal tendon bulging associated with the calcification (open arrow). c cartilage of the humeral head, D deltoid muscle, H humeral head.[10]

Radiographs

  • Standard Radiographs Shoulder
    • Typically normal
    • Useful to exclude other causes of shoulder pain
    • May show enthesophytes on the tuberosities
    • May show calcific tendinopathy, high riding humeral head

MRI

  • Not routinely required
  • Useful in cases of suspected tear or unclear diagnosis

CT

  • Not routinely indicated
  • May help better characterize osseous lesions in uncertan diagnosis

Ultrasound

  • Most of the rotator cuff can be evaluated with ultrasound

Classification

Neer Classification[11]

  • Stage I: edema and hemorrhage within the rotator cuff
  • 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

Nonoperative

Operative

  • Indications
    • Failure of conservative treatment for a minimum of 6 months
  • Technique
    • Acromioplasty (sometimes referred to as subacromial decompression)
    • Bursectomy
    • Radiofrequency (RF)-based microtenotomy

Rehab and Return to Play

Rehabilitation

  • Needs to be updated

Rehab Program PDFs

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

Prognosis and Complications

Prognosis

  • Conservative therapy
    • 46% of people improve with conservative therapy at 6 months, 77% at 18 months[14]
  • Surgical outcomes
    • Low-to-moderate quality evidence acromioplasty is no more effective than exercises for the treatment of RC tendinopathy[15]
  • After surgical repair, overall rate of return found to be 84.7%[16]
    • 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

Internal

External

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. ↑ 4.0 4.1 Hermans, Job, et al. "Does this patient with shoulder pain have rotator cuff disease?: The Rational Clinical Examination systematic review." Jama 310.8 (2013): 837-847.
  5. ↑ de Witte, Pieter Bas, et al. "Study protocol subacromial impingement syndrome: the identification of pathophysiologic mechanisms (SISTIM)." BMC musculoskeletal disorders 12 (2011): 1-12.
  6. ↑ 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
  7. ↑ 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.
  8. ↑ Boykin, Robert E., et al. "Rotator cuff disease–basics of diagnosis and treatment." Rheumatology Reports 2.1 (2010): e1-e1.
  9. ↑ Case courtesy of Varun Babu, Radiopaedia.org, rID: 50866
  10. ↑ Aina, Rima, et al. "Calcific shoulder tendinitis: treatment with modified US-guided fine-needle technique." Radiology 221.2 (2001): 455-461.
  11. ↑ Neer, C. S., II. Impingement lesions. Clin. Orthop. 173:70-77, 1983.
  12. ↑ 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.
  13. ↑ 13.0 13.1 13.2 13.3 Toliopoulos, Panagiota, et al. "Efficacy of surgery for rotator cuff tendinopathy: a systematic review." Clinical Rheumatology 33.10 (2014): 1373-1383.
  14. ↑ Bartolozzi, A., D. Andreychik, and S. Ahmad. Determinants of outcome in the treatment of rotator cuff disease. Clin. Orthop. 308:90-97, 1994.
  15. ↑ Toliopoulos, Panagiota, et al. "Efficacy of surgery for rotator cuff tendinopathy: a systematic review." Clinical Rheumatology 33.10 (2014): 1373-1383.
  16. ↑ 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
Last edited:
13 December 2025 18:51:51
Categories:
Retrieved from "https://wikism.org/w/index.php?title=Rotator_Cuff_Tendonitis&oldid=39220"