Rotator Cuff Overuse: Tendonitis, Impingement, and eventual Tear

The rotator cuff is a group of four muscles tendons that help stabilize and rotate the shoulder. Without this group of four muscle tendons, we would not be able to do many of the activities that we do on a daily basis. Interestingly, there are several injuries that can happen to the muscle-tendon complex called the rotator cuff. Such examples include pain like tendonitis and impingement or even a tear that can cause disability and really make for an unfortunate life change if not managed correctly.

Rotator Cuff Tendonitis and Shoulder Impingement are two conditions that typically result from overuse. If you are an overhead athlete, like a swimmer, or even do repetitive overhead motion as a career such as an Electrician, the tendons of the rotator cuff may get pinched against the acromion, which is a bony process of the scapular or shoulder blade that wraps around to the top of the shoulder and acts as the “roof” of the shoulder. Over time, the pinching and rubbing can cause inflammation of the tendons. The rotator cuff tendons are actually what is called hypo-vascular, which means that they do not have a great blood supply. Which is a significant notation and explains why it takes longer for these tendons to heal once they become inflamed.

Tendonitis is normally the first sign that there is something amiss with the normal joint mechanics of the shoulder. Tendonitis is characterized by some swelling and dull aches at rest and can progress to pain during activity as it worsens. If the tendonitis goes untreated, it can worsen and develop into an impingement syndrome. Impingement Syndrome is characterized with more of a thickening of the tendon, which in turn causes more friction between the tendon and the acromion leading to a greater propensity of pinching. Eventually, the rotator cuff and the deltoid may become visibly weaker as compared to the opposite side of the body as this cycle continues and may be self-perpetuating until an intervention is made.

Chronic Impingement syndrome can eventually lead to tendon degeneration. If the wear and pinching continues untreated, then it can lead to the point of a partial or even full thickness tendon tear. Rotator cuff tears are serious injuries and may require surgery in many cases. Rotator cuff tears can also occur from falls or quick upward and outward motions of the arm. Additionally, sometimes something like a small fall on your shoulder may cause the already weakened tendon to tear if the tendon has already started to show signs of degeneration. It should have been strong enough to withstand the force but was not because of the process of degeneration and wear and tear.

Interestingly, X-rays cannot confirm whether or not a rotator cuff tear is present so an MRI is needed to verify the presence of a tear. Rotator cuff tears typically have limited active motion, especially in abduction and external rotation, but they still may have full passive range of motion. After a surgery to repair a torn rotator cuff tendon, the shoulder is typically immobilized for a certain period of time which is determined by the surgeon. After the immobilization time is over, physical therapy is recommended to help you regain your full range of motion and strength. Physical therapy starts with gentle passive range of motion and eventually will progress you to active exercises to help you strengthen the rotator cuff muscles. Your surgeon and your physical therapist will lay out a timetable of how many weeks the immobilization period lasts as well as when to start progressing from passive to active motion. Each surgery is different depending on the severity of the tear so your surgeon may adjust the timetable based on how well you are progressing.

If you are struggling with shoulder pain and think it may just go away, don’t wait until it gets worse. Come and visit a physical therapist today. Also, if you are having pain in your shoulder, whether at rest or during an activity, it is best to seek treatment to prevent further damage. The first place to start is physical therapy. Physical therapy will focus on using modalities and manual therapy to help decrease pain and inflammation in the early stages of treatment and progress to exercises to help strengthen your rotator cuff.