The shoulder has a greater range of motion than any other joint in the body. It’s also more likely to get injured. The large, powerful deltoid muscle gives shoulder motion most of the power. Underneath this muscle are four rotator cuff muscles (subscapularis, supraspinatus, infraspinatus, and teres minor). They attach to bone by tendons. The rotator cuff is made up of these muscles and tendons that attach the arm to the shoulder joint and allow arm movement. Rotator cuff tendinosis is an overuse injury of the muscles/tendons of the rotator cuff. RC tendinosis is a form of shoulder impingement, and other common names include tennis shoulder, pitchers shoulder, or swimmers shoulder.
Rotator cuff tendinosis is characterized by decreased tendon strength, tendon degeneration, and can also be caused by compression of the rotator cuff tendons by other structures. Sports that involve repeated overhead activities, especially when leaning forward, such as basketball, swimming, lifting weights, and tennis can be difficult. In some jobs, such as house painting and carpentry, the arm must be raised and lowered often. This motion puts stress on the shoulder that can also cause overuse of those muscles and tendons. Being older than 40 years is also related to higher risk of having rotator cuff tendinosis.
The main symptoms are shoulder pain, weakness, or fatigue, or any combination of these. The pain is often worse when moving the arm sideways up over the head and with overhead activities, such as hair brushing. The pain can also be worse at night.
The health care provider can diagnose the rotator cuff tendinosis by means of a medical history and physical examination. A history of a fall on an outstretched hand, pain or weakness with overhead activities, or pain at night are common. On physical examination, the health care provider can often find the problem by putting the shoulder through ranges of motion that reproduce the pain, testing the muscles that form the rotator cuff and the other muscles that surround the shoulder, and doing special tests to look at the other parts of the shoulder. Magnetic resonance imaging (MRI) of the shoulder can help when the health care provider thinks that a rotator cuff tear is present.
The first treatments to try are ice, using nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or acetaminophen for pain, and relative rest (limiting the activities that cause pain). Physical therapy to maintain normal range of motion, strengthen the rotator cuff muscles and the other muscles that provide support to the shoulder (scapular stabilizers) can be useful if the pain persists. Surgery is rarely needed, unless a significant rotator cuff tear or other shoulder problem that doesn’t go away with other treatments is present.
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