A CHIROPRACTOR Talks about Rotator Cuff Tendonitis

Rotator cuff tendonitis a condition I have been seeing much more of in my office these days.  Rotator cuff tendinitis is a degenerative condition of any one, or a combination of any of the four rotator cuff tendons. The Supraspinatus and Infraspinatus are the most commonly affected (there are 4 muscles that make up the rotator cuff, other than the two noted, the others are  teres minor, and subscapularis, which are affected much less often)


Rotator cuff tendonitis symptoms.

Symptoms of rotator cuff tendinitis include pain in the shoulder when rotating the arm especially against resistance. There may also be pain on abduction (raising the arm out to the side) if the Supraspinatus muscle is involved. There is likely to be tenderness when pressing in on the affected tendon which may also feel thickened. A creaking feeling called crepitus may be felt when moving the shoulder.


Causes of Rotator cuff tendonitis

Rotator cuff tendonitis is a degenerative, overuse injury. It is caused by repetitive movements rather than one sudden injury, called Repetitive Stress Injuries

The reason why a rotator cuff tendon develops tendonitis is usually at least in part, related to poor posture (a topic covered in earlier posts of mine).  A forward, rounded shoulder reduces the space in the joint through which the tendons pass. This can lead to the tendons rubbing on the underside of the acromion process at the top of the shoulder joint. Repeated friction leads to pain and deneration. Thickening of the tendon can make the situation even worse and may lead to an impingement syndrome.

Rotator cuff tendonitis may also be called tendinopathy which is a more accurate name for the condition. The ‘itis’ at the end of tendonitis refers to inflammation, which has been shown to be absent in this condition. Tendonitis is still the most commonly used term.

Other similar terms include tendinitis, which is simply an alternative spelling, and tenosynovitis which is degeneration of the sheath surrounding the tendon.

Rotator cuff tendonitis treatment

What can the athlete do?

• Rest from activities which cause pain. The more you use the shoulder the longer it will take to heal and it may become chronic.
• Apply ice  or cold therapy. Ice can be applied every hour for 10 minutes initially reducing to 15 minutes every 3-4 hours as required. This will reduce pain and inflammation.
• See a sports injury specialist who can diagnose the injury and advice on a course of rotator cuff tendonitis treatment and rehabilitation.

What can a chiropractor do?

• Examine the injury to confirm the diagnosis. A number of shoulder examination tests will be done to determine which of the rotator cuff tendons are injured and how badly. The chiropractor may ask you to reproduce movements which bring on pain, particularly resisted shoulder rotation exercises in the case of rotator cuff injury.
• An MRI or ultrasound scan will help with diagnosis enabling the doctor to see more clearly any damage to the shoulder.  If a trauma is an underlying cause, an x-ray will be ordered first to rule out issues related to the skeleton.
• Once the chiropractor is sure of the diagnosis they will employ techniques to reduce pain and inflammation which may include prescribing anti inflammatory medication or the use of electrotherapy treatments such as ultrasound and laser.
• Sports massage may be used to relax tight muscles in the shoulder in general. If the injury is chronic and not responded to initial conservative treatment such as cold therapy as well as expected then cross friction massage may be applied to the tendon itself. This can break down any adhesions between the tendon and sheath surrounding it and reduce the injury to its acute stage to encourage correct healing.
• A good chiropractor will help determine the cause of the injury whether that be poor technique or work related repetitive overuse and identify strategies or changes to avoid the injury recurring. In particular poor posture and muscle imbalances can be corrected with exercises, taping and workspace evaluation.
• A full rehabilitation program to strengthen the associated muscles and correct muscle imbalances is important and should be continues long after the shoulder pain has gone.

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