Rotator Cuff Tendinopathy, By Mahmud Ibrahim MD

The shoulder is one of the most mobile joints in the body. The rotator cuff is a group of muscles that attaches to the shoulder joint via tendons. These tendons not only control the movements of the shoulder, but also help to stabilize the shoulder joint. Over time, patients can develop “wear and tear” of the rotator cuff, called tendinopathy. Tendinopathy can range from slight inflammation of the rotator cuff to a tear of the tendon. Rotator cuff tears are rarely seen in patients under the age of 40. Other risk factors for rotator cuff tendinopathy include repetitive overhead movements, weak shoulder muscles, forward posture of the shoulders, heavy lifting, and a direct blow to the shoulder. Diabetics are at increased risk for developing tendinopathy. Symptoms can include shoulder pain, especially with overhead activities or reaching behind, pain when lying on the affected shoulder, popping or clicking in the shoulder, and limited motion of the shoulder. Initially, symptoms may improve with rest; however, as the degeneration continues, the pain can become constant and occur even at rest. Eventually, the pain can interfere with daily activities. In addition to a physical exam, rotator cuff tendonapathy can be diagnosed with an MRI or ultrasound of the shoulder. Ultrasound is useful as it is (1)noninvasive, (2)can be performed in the office, (3)does not involve being placed in a small tube like structure, (4)and takes only about 5-10 minutes. Ultrasound has actually been found to be more sensitive than MRI in detecting rotator cuff problems. In addition, the physician can show the patient the affected areas in real time.

TREATMENT

First line treatment for rotator cuff tendinopathy usually includes physical therapy to help strengthen the rotator cuff muscles, correct the poor posture, and teach proper form for lifting and overhead activities. Medications can include oral anti-inflammatories as well as other pain medications. Ice is also helpful to reduce inflammation. When oral anti-inflammatories are not enough, it may be necessary to perform a corticosteriod injection into the shoulder to help reduce the inflammation. Ultrasound can also be used when injecting the shoulder as it allows the physician to directly visualize the needle and ensure the medication is being injected directly into the affected area. Newer treatment options also include Platelet Rich Plasma, also known as PRP. This treatment involves taking the patient’s own blood, spinning it down, concentrating and extracting the growth factors in the blood, and injecting those growth factors directly into the affected area. This has been shown to actually promote the healing of degenerated tendons. There are also several surgical options available, but they are more invasive and are therefore rarely considered first line treatment options.

Shoulder pain is a common problem. With the proper treatment, the pain can be significantly reduced and improve a patient’s quality of life. For more information or to schedule a consultation, please call our office in Lawrenceville, NJ at 609-588-8600.

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