SHOULDER PROBLEMS
Rotator Cuff Tendinitis / Impingement / Bursitis
Rotator Cuff Tendinitis is an overuse condition that causes pain and
disability in the shoulder and upper arm. It is often referred to as
impingement or bursitis. All three names refer to the same
condition, caused by using the arm and shoulder in tasks that are
repetitive and often involve moving the arm above the level of the
shoulder.
Causes and Symptoms
Common athletic activities that produce this condition are racquet sports,
swimming, throwing, weight lifting and calf roping. As the athlete
increases activity levels too quickly or works out for long periods
of time, the muscle-tendon groups may become inflamed. Pain,
tenderness and inability to perform shoulder movements result.
Other activities such as painting, driving or carpentry also may cause
and/or aggravate the condition. Tendinitis often brings pain with
such activities as combing your hair, putting on a jacket, tucking
in your shirt, or sleeping on the shoulder or with your arm over
your head. The condition may be acutely painful, or it can be
chronic with a dull pain lasting months.
Diagnosis
There are several components to diagnosing rotator cuff tendinitis:
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Your physician will take a careful history.
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Specific tests on physical examination.
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X-rays may be helpful to detect bone spurs.
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Occasionally, an injection of xylocaine into the bursa adjacent to the cuff
will alleviate pain, and helps to confirm the diagnosis.
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In complicated cases, an MRI (magnetic resonance imaging) may be
ordered to carefully evaluate the cuff tendons for tears or degeneration.
Treatment
Treatment is usually non-surgical. The goals of the treatment program are
first to lessen the inflammation and then stretch and strengthen the
rotator cuff muscles. The inflammation can usually be controlled
with rest, ice and oral medication (anti-inflammatory).
It is best to reduce or stop the offending activity. This may mean
stopping or reducing yardage in a swimming program or only volleying
with no overhead serves in tennis. You may also need to modify or
stop certain work activities (i.e., use of a computer mouse,
painting, etc.) for a period of time.
After the inflammation has been controlled, your physician will most
likely prescribe a stretching and strengthening program. It is
important that you stay with the program to achieve lasting results.
At the beginning of the strengthening program it may help to ice
your shoulder after the exercises. The stretching exercises are done
before the strength exercises to warm up and stretch out the cuff
muscles.
Perform the following exercises at least four times a week, preferably
daily, with occasional days of rest.
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Stretch
1
Bring
hand of affected arm to opposite shoulder. Pull shoulder
forward slightly. You should experience a slight stretch in
the affected shoulder. |
|
Exercise
1
With
the arm in an “empty can” (thumb down) position, and at
a 45 degree angle to the body, raise the extended arm to 45
degrees or as pain allows. |
|
Stretch
2
Place
affected arm up and over head, with hand resting on back of
(or extended toward) opposite shoulder. Slowly stretch bent
elbow back. |
|
Exercise
2
This
can be performed standing with surgical tubing, or lying on
the injured side with free weights (see below). Start with
high repetitions of slow-controlled movement and progress
with increased weight or tension on the tubing. |
|
Stretch
3
Bring
hand of affected arm to opposite shoulder. Pull shoulder
forward slightly. You should experience a slight stretch in
the affected shoulder. |
|
Exercise
3
Lie
on a table with elbow on the edge and hand hanging over,
with weight in hand. Raise the weight parallel with the
ground to the level of the table or your head (keep back
flat and do not arch). Lift elbow towards the ceiling and
squeeze the shoulder blades together. Start with low weight
and work on your technique. Do not swing the weight up.
Remember: slow and controlled. Increase weight as strength
builds. |
Note: You may feel some discomfort. But you should not feel
pain. These methods may work by themselves or may require the
additional use of physical therapy (ultrasound, electrical
stimulation, etc.). Surgical solutions to the problem are usually
considered if home care and/or structured therapy for the problem is
unsuccessful.
Prevention
It is important to moderate training sessions and take adequate
periods of rest between training sessions to help in the prevention
of tendinitis. Warming up, stretching and strengthening are also
good components of prevention. Early attention to soreness in the
shoulder and upper arm during training or after a session may
prevent a chronic problem. Treatment of shoulder symptoms should be
started as soon as noticed.
This
information is provided by Orthopaedic Center of the Rockies as
basic information about a specific orthopaedic topic. It is not
intended as a personal reply to your specific questions or concerns.
For more information, please contact your physician or a physician
at Orthopaedic Center of the Rockies, (970) 493-0112 or
1-800-722-7441.
©
Orthopaedic
Center of the Rockies 1999
IMPORTANT NOTE
The information on this website is general in nature and is only intended to provide
a summary of the subject matter covered. It is not a substitute for medical
advice and you should always consult a trained professional practising in the
area of sports medicine in relation to any injury. You use or rely on
information on this website wholly at your own risk and no party involved in the
production of this website accepts any responsibility for the information
contained on it or your use of that information.
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