Rotator Cuff Tendinopathy - Shoulder Pain

Rotator Cuff Tendinopathy

Rotator cuff tendinopathy is a common condition among people involved in repetitive overhead activities, resulting in degeneration of rotator cuff tendons. However, other soft tissues and structures will also be impacted, affecting joint mechanics, stability and tensional forces. Soft tissues include ligaments, tendons, muscles, bursae fascia and parts of joint structures. The rotator cuff consists of four muscles forming the acronym SITS: Supraspinatus, Infraspinatus, Teres Minor and Subscapularis. The four muscles play a major role in Glenohumeral Joint (GH) integrity. Three of the muscles help keep the ball (humeral head) within the socket (Glenoid Fossa) of the scapula. The remaining muscle, the Teres Minor, attaches part of the upper arm (the humerus) to the medial border of the scapula. The SITS muscles also play a major role in GH joint shoulder mobility, abduction and internal and external rotation.

Unlike a rotator cuff tear, which relates to the SITS muscles, tendinopathy affects the tendon portion of the muscles. Microtrauma to the tendon results in inflammation, which is part of the body's healing process. However, this can create pain, restrict mobility and result in further trauma and a downward cycle. This cycle can limit mobility, cause pain and result in tendon degeneration, affecting multiple aspects of daily life. Symptoms gradually get worse, unless the root cause is identified and addressed. The severity of the tendinopathy will impact the symptoms and level of shoulder mobility and pain. Much like SITS muscle tears, tendinopathy involving one muscle may impact multiple types of shoulder motion due to how the muscles are attached (origin and insertion). The image below is an oblique view of the left shoulder, with the SITS muscle highlighted, and the white sections highlight the tendon portion of the muscles.

Rotator Cuff Tendinopathy

Images produced with kind permission of 3d4medical.com from Essential Anatomy 5

Causes of Rotator Cuff Tendinopathy

Shoulder Pain and Rotator Cuff Tendinopathy.

Rotator cuff tendinopathy can occur due to acute injuries and chronic overuse. Key contributing factors include:

Biochemical Factors - Age-related degenerative changes can lead to a decline in tendon soft tissue makeup, making them susceptible to injury.
Repetitive Overhead Activities - Occupations and sports that involve consistent overhead motions, such as baseball, swimming, and construction work, can irritate the rotator cuff tendons.
Postural Issues - Poor posture, such as rounded shoulders or forward head position, can alter shoulder mechanics and lead to tendon strain.
Previous Injuries - Previous shoulder injuries can increase the likelihood of developing tendinopathy due to altered mechanics or via chronic inflammation.

Symptoms of Rotator Cuff Tendinopathy

Rotator cuff tendinopathy can produce a variety of symptoms, depending on severity and what is affected, such as:

Shoulder Pain - Gradual onset of pain, often made worse by overhead activities, reaching, or lifting.
Weakness - Difficulty in performing daily activities or sports requiring arm elevation.
Stiffness - A feeling of shoulder joint tightness, particularly after rest or inactivity.
Impingement Signs - Pain during specific movements, such as raising the arm, may indicate possible impingement.

Differential Diagnosis

There are many causes of shoulder pain, often with similar symptoms to rotator cuff tendinopathy, such as:

Rotator Cuff Tear - Complete tears often result in more severe symptoms and functional limitations.
Subacromial Bursitis - Inflammation of the bursa can present similar symptoms, though may have a lesser impact on strength.
Shoulder Arthritis - Degenerative joint disease may involve pain and stiffness, but differs in the mechanical nature of the symptoms.
Labral Tears - These injuries may present with clicking or catching sensations in addition to pain.

An accurate diagnosis often requires a detailed history, physical exam and imaging studies, such as X-rays, MRI or ultrasound.

Treatment Options

Effective treatment for rotator cuff tendinopathy typically involves a mixed approach:

Manual Therapy - Targeted exercises and stretches can improve shoulder strength and flexibility and enhance overall function.
Medications - Non-steroidal anti-inflammatory drugs (NSAIDs) can alleviate pain and reduce inflammation.
Injections - Corticosteroid injections may help in managing severe pain, providing temporary relief.
Surgery - In cases where conservative measures fail, surgical options may provide relief by repairing tendon tears or relieving impingement.

Self-Care Strategies

Self-care strategies can greatly assist recovery and prevention:

Activity Modification - Avoiding movements that worsen pain and opting for low-impact activities can aid healing.
Ice Application - Ice packs post-activity can help reduce inflammation and alleviate pain.
Strengthening and Stretching Exercises - Regular, guided exercises can promote recovery and prevent future injury.
Ergonomic Adjustments - Improving posture and modifying tasks to reduce overhead strain can aid in management.

The article was written by Terry Davis MChiro, GradCertMentHlth, BSc. (Hons), Adv. Dip. Rem. Massag., Cert. WHS.

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About the Author

As of December 31st 2020, the author chose to leave the Chiropractic profession due to a planned move back to Australia, where his training and education are not recognised. Terry no longer works as a Chiropractor and works as a Myotherapist in Morningside, Brisbane. He developed an early interest in soft tissue therapy and Myofascial Release Techniques and that interest has continued to develop since 2006. Terry's interests in human performance and trauma have naturally led to him developing a specialism in treating work and sports-related musculoskeletal injuries and Chronic Pain symptoms.

The author possesses an unusual background for somebody who trained in the McTimoney Chiropractic technique. His education, training, and practical experience span over two decades and relate to health's physical and mental aspects. He also needed to push his body and mind to the limits of physical and psychological endurance as part of his time serving in Britain's elite military forces. His education includes a bachelor of science degree in Business Management, with a specialisation in psychology and mental health in the workplace, an Masters of Chiropractic, MChiro, a Postgraduate Certificate in Mental Health and a multitude of soft tissue therapy qualifications (see the about section for more details). His soft tissue qualifications range from certificate level right through to a BTEC Level 5 Advanced Diploma in Clinical Sports and Remedial Massage Therapy. He has also taught as a senior course coach teaching Remedial Massage and the Advanced Diploma Myotherapy in Australia. His teaching involved both theoretical and practical aspects, including advanced Myofascial Release Techniques and has certification in training and assessment. Terry will have taught many of the first students to train as Myotherapists in Brisbane. Terry's combination of knowledge through education, training, elite military service, and personal injury history has paid dividends for the patients he sees and has treated over the last 19 years. Terry is still extremely active and enjoys distance running, kayaking, mountain biking and endurance-type activities.