This term means the same thing as bursitis or tendonitis of the shoulder. There are several causes of this problem. In some people, the most common cause is overuse, such as repetitive throwing, weightlifting, overhead racquet sports, swimming, and so forth; it can also occur in people not performing athletic activities, but daily repetitive activities, such as using a computer mouse, carrying/lifting objects or typical household cleaning. In some people, these activities lead to inflammation or tendonitis.
As mentioned above, the rotator cuff is composed of four muscle-tendon units, and any or all of these can be involved. The upraspinatus and the biceps are the most commonly involved. What overuse does to the tendons is not known absolutely. It is felt that with overuse small, microscopic tearing of the tendon fibers occurs. Most tendons have an area of poor blood supply within the tendon itself. This makes the body’s attempt at healing these microtears not totally successful. We think this leads to an irritative process in the tendon which is called tendonitis with ultimately results in chronic thickening of the tendon, known as rotator cuff tendinosis.
Symptoms are generally those of pain, usually after activity at first, and then during activity. The pain can usually be relieved by rest, but in some cases, the pain may be rather severe and require more specific treatment. The general treatment for this group of patients is nonsurgical, including prolonged rest, sometimes often six weeks or more, and appropriate exercises to strengthen and stretch the rotator cuff muscles and tendons.
In throwing athletes and some swimmers, the anterior or front muscles of the rotator cuff (the subscapularis, the biceps, and the supraspinatus) are too strong, and the back muscles (the infraspinatus, teres minor and occasionally the supraspinatus) are weak. Rest and exercises along with the use of nonsteroidal anti-nflammatory drugs and an occasional injection of cortisone will almost always result in improvement. The use of heat for l0-15 minutes before exercise and workouts, as well as the use of ice afterwards is also important.
If an individual wishes to return to athletics during this time, then it can be done with some indicated modifications of the activity, strengthening exercises, symptomatic treatments with heat before and ice after, as well as the occasional use of NSAIDS (nonsteroidal anti-inflammatory drugs). An individual who follows these prescribed recommendation will usually be able to continue participation in their sport at the desired frequency and level. Some throwing athletes and others involved in overhead athletic activities will develop rotator cuff tendonitis secondary to instability or subluxation of the shoulder. If the above-described conservative, non-surgical treatment fails in the group of patients, then surgery to reconstruct or stabilize the shoulder may be indicated. This subject is covered in another handout covering shoulder instability and dislocations.