Tendinopathy and Bursitis

There is an increased incidence of rotator cuff tendinopathy in patients who are manual laborers and whose work involves high degrees of repetitive motion.  There is also an increased incidence of rotator cuff tendinopathy in overhead or swinging athletes, including baseball players, tennis players, and golfers.  These occupational or sporting activities result in compression by the overlying acromion and repetitive eccentric (muscle elongation during contraction) loading of the rotator cuff.  Sometimes, however, patients develop rotator cuff tendinopathy without a history of these activities, and the condition just appears, which in medicine is referred to as “idiopathic”.

We know there are clear risk factors that predispose to the development of rotator cuff tendinopathy, including advancing age, movement problems with the shoulder blade (scapular dyskinesia), and anatomic variations of the bone of the acromion. There is an increased incidence of rotator cuff tendinopathy also observed in patients with specific medical comborbidities, including obesity and diabetes.

Sometimes pain from rotator cuff tendinopathy develops as part of a traumatic insult to the shoulder, as during a direct blow to the arm, a fall, or a forceful jerking motion of the arm as can occur during a work-related injury. When there is a history of a traumatic event, it is important to seek evaluation to ensure there is not any substantial structural damage to the rotator cuff tendon (ie, tears). When you make an appointment with shoulder surgeon Dr. Obermeyer, he will examine your shoulder and discuss next steps for evaluation or treatment, and whether an MRI would be a useful tool to understand the extent of any damage to the rotator cuff tendon.

The diagnosis of rotator cuff tendinopathy involves a detailed history and physical examination, and initially xrays to diagnose bone spurs and the presence of anatomic variants of the acromion bone that can contribute to tendon disorders.  Sometimes an MRI scan can be helpful to confirm the diagnosis, and further understand the presence of other associated conditions affecting the shoulder, including arthritis, tears, and other conditions.  Not all patients require MRI scanning for the diagnosis, however, and Dr. Obermeyer will discuss the circumstances of your case to determine what additional testing is necessary.

Generally, the treatment of rotator cuff tendinopathy involves surgical and nonsurgical options.  Fortunately, the majority of patients can be treated successfully without the need for surgery.  The good news is that in the minority of patients that require surgery for this condition, it is very successful, has a relatively brief and straightforward recovery process, and cures the condition.

The strategy with the nonsurgical approach involves initially managing the pain which can be achieved with heat and ice, and oral medications.  Sometimes there are activities that are problematic and modifying these can be helpful. Dr. Obermeyer will discuss with you whether a corticosteroid injection (cortisone) injection would help, which can be helpful in some cases to improve range of motion and for temporary pain benefits.

The mainstay of the treatment for rotator cuff tendinopathy involves physical exercises and rehabilitation.  Often a physical therapy consultation is helpful for guidance, feedback on the exercises, and to improve compliance and success of the prescribed regimen.  Physical therapy involves strengthening of the rotator cuff and scapular (shoulder blade) muscles, to ensure that appropriate muscle activation and coordination is occurring.  Certain stretches of the shoulder (“posterior capsule”) are additionally beneficial to minimize irritation of the damaged rotator cuff tissue from the overlying spurs and bone of the acromion.

Overhead athletes are equally benefitted from a structured exercise program, as the same muscles weakness and dyskinesia that cause pain in the weekend warrior can help the high-level athlete.  Oftentimes additional exercises to improve posture, core strength, proper scapular positioning during sport, and muscle endurance can be helpful for athletes.  Dr. Obermeyer and your physical therapist will ensure that program is designed for success and tailed to your specific needs.