Rotator cuff tendon injury
The shoulder joint is a ball and socket structure which is surrounded by soft tissues which provide support and movement to the joint. The rotator cuff muscles play an important part in this and stabilise the ball onto the socket. These muscles attach to the ball via an overlapping mesh of tendons, called the rotator cuff, which are susceptible to injury.
The commonest injury is painful irritation of one or more of the tendons (called a tendinopathy). This normally occurs with sudden or gradual overuse of the shoulder during overhead sports or day to day activities. This irritation can also cause inflammation of a structure which surrounds the rotator cuff tendons called the ‘bursa’ and inflammation of this structure is therefore described as a bursitis. The combination of tendonitis and bursitis in the shoulder is sometimes called ‘shoulder impingement’, although this term is less commonly used nowadays.
What are the symptoms of rotator cuff tendonitis?
Symptoms of tendonitis or bursitis include pain in the shoulder and upper arm which is worsened when raising the arm above shoulder height or reaching backwards. It can also be painful to lay on the affected side, causing sleep disturbance at night, as well as lifting heavier objects with the affected arm.
Who gets rotator cuff tendonitis?
As mentioned above, sudden or gradual overuse of the arm above shoulder height is the usual trigger for developing tendonitis or bursitis. Some individuals can also be more prone to this injury such as those with diabetes or who are overweight or obese. This type of injury is also more common with increasing age. Tendon injury can also sometimes occur if there is a fall onto the shoulder or a sudden yanking of the arm, although this is more likely to result in a tear to the tendon which is discussed further below.
How do you diagnose rotator cuff tendonitis?
Diagnosis typically consists of a careful clinical history and examination and is often confirmed with either MRI or diagnostic ultrasound. Dr Collins specialises in combining all these elements into a single consultation to provide a rapid and clear understanding of what is causing your symptoms.
How do you treat rotator cuff tendonitis?
Tendonitis can usually be treated with rehabilitation care which involves:
- Adjusting activities for a period to allow the injured structure to recover
- Exercises to strengthen the other stabilising muscles which helps offload the injured area
The British Elbow & Shoulder Society have produced a patient resource for this condition which provides information and a good home exercise program to help rehabilitate the shoulder. Rehab care can also be supervised by an experienced physiotherapist and Dr Collins will be able to recommend a suitable therapist. Tendon injuries are slower to heal than some other types of injury, so the period of rehabilitation is typically between 6-12 weeks assuming careful compliance with the treatment prescribed.
Occasionally pain from the tendonitis can persist despite careful rehabilitation or might even restrict the rehabilitation process, in which case an ultrasound guided injection of anti-inflammatory steroid around the tendon can help settle the pain to allow rehabilitation to progress more effectively. This is likely to be most effective where there is also evidence of bursitis. Dr Collins can recommend when injection therapy would be most helpful and perform this under ultrasound guidance to ensure accuracy of placement and reduce discomfort associated with injection treatments.
Rotator cuff tendon tear
As mentioned above, a sudden and higher impact injury to the shoulder may result in the rotator cuff tendon tearing. The risk of this increases after the age of 50 as tendon strength decreases with age, but younger people can experience this type of injury if the force is particularly significant (such as with a shoulder joint dislocation or fracture to the bones around the joint).
How are rotator cuff tendon tears treated?
There are different types of tendon tears depending on their location and size so the right treatment depends on the type of tear and person affected. Generally speaking, the younger the patient and more extensive the tear the more likely surgical treatment will be recommended, and the smaller the tear and older the patient the more likely non-surgical treatment is appropriate.
Non-surgical treatment is usually the same as for tendonitis with a period of physiotherapy led rehabilitation over 6-12 weeks. As with tendonitis and bursitis, if pain is particularly troublesome then an ultrasound guided injection with anti-inflammatory steroid might be appropriate to help control symptoms to allow rehab to progress.
In cases where surgical repair may be the best treatment option, this is usually done using key hole surgery and can even be done with regional anaesthesia called awake surgery which avoids the need for a general anaesthetic and better post operative experience. Dr Collins works closely with a large number of shoulder surgeons and is able to recommend a suitable specialist if required.
Rotator cuff calcific tendonitis – what is it?
This condition is usually not associated with any injury or tendon overuse but happens when there has been a build-up of calcium within the tendon which then spontaneously starts to dissolve causing severe inflammation in and around the tendons. We are not fully sure why calcium builds up in the rotator cuff tendons as many people have tendon calcium which never dissolves and so never develop any inflammation. However, when the process of dissolving occurs, a very painful tendonitis and bursitis develops.
Calcific tendonitis can be diagnosed by diagnostic ultrasound after taking a detailed history and examination. This condition does not normally respond well to rehabilitation treatment with an anti-inflammatory steroid injection being recommended instead to settle the inflammation. Occasionally, where the build-up of calcium persists and the tendon pain won’t fully settle, an injection procedure called a barbotage can be performed to break up the calcium. Dr Collins is experienced in providing this treatment.
Please contact us to discuss the treatment of rotator cuff tendon and bursal problems and the procedures Dr Collins provides for this.