Rotator Cuff Tendonitis

What is rotator cuff tendonitis

Rotator cuff tendonitis or tendinitis occurs when the muscles and tendons of the rotator cuff that help to move the shoulder become inflamed or damaged. It is often called tennis shoulder or swimmer’s shoulder due to its high incidence among swimmers, tennis and volleyball players.

Rotator Cuff Tendonitis

Rotator cuff calcific tendonitis is another, more serious form of the condition, occurring when the supraspinatus tendon develops calcium deposits due to wear and tear of aging, resulting in pain or sleep disturbances and even immobility in the shoulder.

Rotator cuff tendonitis signs and symptoms

The most recognizable initial symptom is pain felt in front of the shoulder that continues to the side of the arms, but does not cross the elbow. Along with this, a clicking sound may also be heard when lifting the arm.

As the ailment progresses, the symptoms become acute and may lead to sleep disturbances due to pain felt at night. The affected arm is gradually rendered immobile, stiff and numb, eventually making it hurtful to raise the hand, throw something or put the hand behind head.

Rotator cuff tendonitis causes

The primary cause is considered to be the repeated overhead movement necessary in sports like tennis, baseball and volleyball. Activities such as working on computers for long hours, keeping the arms in the same position may also lead to the problem. Other possible causes include activities like weightlifting, kayaking and playing certain instruments like violin regularly.

Risk factors

You are more likely to develop this type of tendonitis if:

• You are over 40 years of age
• Are suffering from a rotator cuff tear or impingement syndrome
• Have a history of a shoulder injury
• Sleep in the same position every night
• Have a chronic condition like diabetes or rheumatoid arthritis that may inflame the rotator cuff muscles

Rotator cuff tendonitis diagnosis and tests

The doctor usually begins with a full examination of the shoulder to detect the exact position of the pain and tenderness. This is usually followed by an estimation of the range of motion of the shoulder, where you may be asked to move your arm in certain directions.

The strength of the neck may also be tested as neck problems such as a pinched nerve or arthritis may also present similar symptoms.

The doctor may also recommend imaging tests for confirming the ailment. X-ray is primarily done to detect bone spur while MRI is done to check for problems such as tearing.

Rotator Cuff Tendonitis MRI

Differential diagnosis

• Scapulothoracic bursitis
• Adhesive Capsulitis
• Biceps Tendonitis
• Calcific Tendonitis Shoulder
• Frozen shoulder
• Snapping scapula syndrome
• Glenohumeral arthritis
• Acromioclavicular arthritis
• Suprascapular neuropathy

Rotator cuff tendonitis treatment

Pain management at home

The first objective of treatment is managing the pain to regain the ability to move the shoulder. The following may help with this purpose:

• Applying ice 3 or 4 times per day on the affected shoulder for 15 to 20 minutes to decrease the inflammation.
• Avoiding exercises that may increase pain such as pushing exercises pushups, bench press at the gym
• Not serving overhand in tennis.
• Avoiding lifting heavy things, and keeping the object close to the body when lifting up anything
• Sitting upright while writing or working on the computer.
• Avoiding swimming apart from sidestroke or breaststroke.

Rotator cuff tendonitis exercises and physical therapy

Once the pain lessens, the doctor suggests physical therapy which involves stretches to help the shoulder to regain strength and motion and avoid further problems.

The doorway stretch requires you to stand in a doorway while keeping the arms stretched. Then, lean forward with each hand firmly gripping the sides of the doorway. Continue leaning forward until you feel your arms stretching. Then slowly as you shift your weight onto the toes, a stretch would be felt in front of the shoulder.

The side lying external rotation requires you to lie on the opposite side of the affected arm. Now, the elbow of the painful side should be bent to 90 degrees and be positioned against the ribcage. Then hold a light weight dumbbell in that hand and gently rotate externally.

Alternative treatment

At times yoga, message or chiropractic therapy can also provide relief. Make sure to go to a licensed practitioner if you consider such treatment options. Certain studies suggest acupuncture to have a positive effect as well, but there is a lack of evidence to confirm the claim. If the pain does not get better or keeps coming back, it is advisable to consult a doctor.

Shoulder taping methods, such as Kinesio taping, may help to support the affected shoulder, reducing the pain and increasing the range of movement to some extent.

Medical treatment

In case the disability does not respond to exercises and home treatment, your doctor may recommend a steroid (cortisone) injection into the affected tendons.

 Surgery

Surgery is recommended only when the tendonitis refuses to heal, increasing risks of other problems such as a tendon tear. Arthoscopy, a keyhole surgery, is the least invasive surgical procedure available for the condition. It is done by making two or three tiny cuts around the shoulder. Through the cuts, the doctor inserts a tool, called arthoscope, with an attached camera to get a view of the site of injury on a television screen. As the picture is displayed on the screen, the doctor is able to monitor the other minute surgical instruments. The noninvasive nature of this surgery warrants as little pain as possible.

How long does tendonitis last: Recovery time

If it affects a person within 30 years, rest and home treatment ensure recovery within 2 to 4 weeks. With the aged, the recovery may take several months. Those having undergone surgery for the problem usually get well within 4 weeks following the procedure.

Rotator cuff tendonitis vs. rotator cuff tear

At times, severe injury such as a fall, a car accident or a direct blow may cause the rotator cuff tendons to tear. Since both the conditions have similar symptoms, it is necessary to differentiate between the two for proper treatment. The diagnosis involves an anesthetic injection in the affected region; in case of a tendinitis, the pain decreases and the muscle strength remains normal in response to anesthesia, while if you have a tear, the muscle function does not improve though the pain subsides.

Rotator cuff tendonitis ICD-9-CM and ICD-10 codes

The ICD-9-CM code used for this shoulder pain is 726.10, while its ICD-10 code is M75.30.