Rotator Cuff Tendinitis
By: Jeff Tanji, MD
Associate Medical Director, Sports Medicine, University of California Davis, Davis, CA

Rotator cuff tendinitis is one of the most
common conditions affecting the shoulder. It
is generally caused by overuse or overload.
Overuse or overdoing shoulder exercise can
happen in sports like swimming or during
throwing sports, where the repetitive motion
of the arm causes irritation to the cuff.
Tensile overload is when the shoulder
experiences a sudden pull or jerk and can
lead to rotator cuff tendinitis. An example of
tensile overload to the shoulder is when a
person is walking a dog and the dog pulls
hard on the leash, resulting in a sudden jerk
or pull to the shoulder.
The rotator cuff muscles are four very small,
fragile muscles named supraspinatus, infraspinatus,
subscapularis and teres minor. The purpose of these four
muscles is to help the arm attach and move properly in the
shoulder socket. Of the four muscles, supraspinatus is the
most important and the most commonly injured.
Symptoms:
When the rotator cuff is injured, pain results from
inflammation to the muscle group. You may feel pain that
is dull, achy, throbbing or piercing. The pain
often does not focus on one spot, but occurs
in the general location of the shoulder. The
pain often worsens when raising the arm
overhead or while resting in bed at night.
The history and physical examination given by
a physician helps make the diagnosis. X-rays
of the shoulder are often taken, but not
always. X-rays do not show the rotator cuff
muscles only the bones of the shoulder, but
may provide useful clues for diagnosis. Most
of the time, a doctor will not request a MRI of
the shoulder until certain treatments have
been tried.
Treatment:
The most common treatments for rotator cuff tendonitis
include:
Ice, anti-inflammatory medications and rest. These basic
treatments focus on reducing inflammation and pain to
the shoulder. If you have already tried these remedies,
your physician may recommend other treatments.
Physical therapy.
Physical therapy will improve your
shoulder condition generally 70 percent of the time. You
have a choice of pursuing exercises under the guidance
of a physical therapist or at home. Physical therapy
exercises focus on strengthening the rotator cuff and
reducing inflammation and pain. One of the benefits of
physical therapy is that the shoulder can improve after
just a handful of treatments (often 6 to 8 therapy
sessions).
Injection to the rotator cuff.
If busy schedules don’t
allow time for physical therapy sessions, an injection by a
physician is a useful treatment. Injecting medication to
the area is successful in improving symptoms from
rotator cuff inflammation about 70 percent of the time.
The injection usually contains about a teaspoon of a
combination of two medications. One is a medicine to
numb the shoulder, like lidocaine. The other is an antiinflammatory
medication, such as cortisone. The injection
is given in a small space of the shoulder called the
subacromial space, not into the shoulder socket. The
shot is generally not painful, and is often compared with
the sensation of having blood drawn from the arm. After
the shot, you should rest the arm for about 48 hours,
which means not doing any heavy lifting or repetitive
motions, to avoid causing additional shoulder pain and
irritation. Check with the governing organization for your
sport first. Some organizations may have a policy
restricting or banning cortisone use.
Pain:
After these treatment choices have been followed, about
85 percent of patients feel a substantial relief of pain.
Most patients experience a great reduction in pain, yet still
have a small amount of pain that slowly improves over
three to six months. It is common for pain from rotator cuff
inflammation to last over many months.
If pain continues, stay in touch with your doctor who may
use further tests to find the cause. Other causes of pain
do not improve with these treatments, such as: a small
tear to the rotator cuff, a tear to the cartilage around the
shoulder joint, a tight bony spot that continues to cause
inflammation or excessive looseness to the shoulder. You
and your physician can make choices about diagnostic
tests if the pain in the shoulder continues.