Rotator cuff tendinitis

• Alternative Names

  Swimmer's shoulder; Pitcher's shoulder; Shoulder impingement syndrome; Tennis shoulder; Tendinitis - rotator cuff

• Causes, incidence, and risk factors

  The shoulder joint is a ball and socket type joint where the top part of the arm bone (humerus) forms a joint with the shoulder blade (scapula). The rotator cuff holds the head of the humerus into the scapula.

  Inflammation of the tendons of the shoulder muscles can occur in sports requiring the arm to be moved over the head repeatedly as in tennis, baseball (particularly pitching), swimming, and lifting weights over the head. Chronic inflammation or injury can cause the tendons of the rotator cuff to tear.

  The risk factors are being over age 40 and participation in sports or exercise that involves repetitive arm motion over the head (such as baseball).

• Symptoms
  • Pain associated with arm movement
  • Pain in the shoulder at night, especially when lying on the affected shoulder
  • Weakness with raising the arm above the head, or pain with overhead activities (brushing hair, reaching for objects on shelves, etc.)
• Signs and tests

  A physical examination may reveal tenderness over the shoulder. Pain may occur when the shoulder is raised overhead. There is usually weakness of the shoulder when it is placed in certain positions.

  X-rays may show a bone spur, while MRI may show inflammation in the rotator cuff. An MRI can show a tear in the rotator cuff.

• Treatment

  Treatment involves resting the shoulder and avoiding activities that cause pain. Ice packs applied to the shoulder and nonsteroidal anti-inflammatory drugs will help reduce inflammation and pain.

  Physical therapy to strengthen the muscles of the rotator cuff should be started. If the pain persists or if therapy is not possible because of severe pain, a steroid injection may reduce pain and inflammation enough to allow effective therapy.

  If the rotator cuff has had a complete tear, or if the symptoms persist despite conservative therapy, surgery may be necessary. Arthroscopic surgery can be used to repair some tears and remove bone spurs and inflamed tissue around the shoulder. Some large tears require open surgery to repair the torn tendon.

• Expectations (prognosis)

  Most people recover full function after a combination of medications, physical therapy, and steroid injections. For patients with tendinitis and a bone spur, arthroscopic surgery is usually successful in restoring them to their pre-injury level of activity.

  People with tears of their rotator cuff tend to do well, although their outcome is strongly dependent upon the size and duration of the tear, as well as their age and pre-injury level of function.

• Complications
  • Bursitis
  • Complete rotator cuff tear
  • Treatment fails to improve symptoms
• Calling your health care provider

  Call for an appointment with your health care provider if persistent shoulder pain occurs. Also call if symptoms do not improve with treatment.

• Prevention

  Avoid repetitive overhead movements. Develop shoulder strength in opposing muscle groups.

• References

  Burbank KM, Stevenson JH, Czarnecki GR, Dorfman J. Chronic shoulder pain: part II. Treatment. Am Fam Physician. 2008 Feb 15;77(4):493-7. Review.

  Burbank KM, Stevenson JH, Czarnecki GR, Dorfman J. Chronic shoulder pain: part I. Evaluation and diagnosis. Am Fam Physician. 2008 Feb 15;77(4):453-60. Review.

Review Date: 8/24/2009

Reviewed By: Thomas N. Joseph, MD, Private Practice specializing in Orthopaedics, subspecialty Foot and Ankle, Camden Bone & Joint, Camden, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.