Rotator Cuff (Shoulder) Tendonitis
What is Rotator Cuff Tendonitis?
Rotator Cuff tendinitis, shoulder bursitis and calcific tendinitis are all relatively common injuries to the shoulder. This type of shoulder condition usually has a slow onset of discomfort and pain in the upper shoulder or arm and/or difficulty sleeping on the shoulder. Sometimes the pain is sudden, with a sharp discomfort when the shoulder is positioned at certain angles.
Each specific rotator cuff injury will have its own symptoms but may include:
Pain radiating from the shoulder down to the elbow or as far as the hand
Pain when lying on the shoulder
Pain at rest
Pain or clicking when the arm is lifted to or up above shoulder height or moved backwards e.g reaching back for the seatbelt in the car
Shoulder muscle weakness or pain on reaching or lifting
They can be caused by repetitive trauma eg gym work, swimming or overuse injuries. It can also be caused by a one off traumatic episode where the shoulder takes a sudden impact e.g. being hit or after a fall onto it.
Shoulder tendinitis with or without calcification is very successfully treated using focused shockwaves with ultrasound guidance during treatment, to stimulate a healing response. About 75% of patients improve significantly within 10 weeks of treatment, even when all other options have failed.
We usually require an x-ray and an ultrasound to have been performed prior to treatment. This is to check that there are no other bony or soft tissue problems that may be causing the pain and to show the more complicated anatomy of the rotator cuff and all the tendons. It may show the presence of calcium deposits which develop as a result of the injury.
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The rotator cuff is made up of four muscles which control your shoulder movements.
The supraspinatus muscle and tendon are the ones most frequently affected by tendonitis and calcification.
The shoulder joint itself is relatively shallow so relies on this group of muscles for stability. They form a cuff around the head of bone at the top of the arm called the humerus.
When the tendons become inflamed and swollen or if the bursa becomes inflamed and swollen impingement can occur where the structures catch on the bony prominence of the acromion as they move, causing clicking, clunking and pain.
For protection, the tendons that attach the muscles to the bone are found underneath the bony prominence of the shoulder called the acromion. Between the tendons and the bone is a sac of cushioning called the Bursa. This protects the tendon from touching the bone. Both the tendons and the bursae can become inflamed.
Calcium may also start to deposit within the body of the inflamed tendon. If this grows large enough it can become a problem in its own right as it takes up more and more space and impingement gets worse.