Rotator Cuff Tendinopathy

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The rotator cuff is a group of four small muscles that surround the shoulder. They work as a unit to help stabilise the shoulder joint and help with shoulder joint movement.

They may be injured through wear and tear (from repetitive movements), improper lifting of a load or a fall. Injuries range in severity from tendon strains to partial and complete tears.

​The main symptoms are an acute onset of pain and painful movement of the shoulder, worse with overhead
activities.

If a tear is present, there may also be weakness. The symptoms may be severe enough to affect sleep and  daily activities such as dressing or bathing.

​Rotator cuff tendinopathy is caused by irritation and inflammation of the tendons of the rotator cuff muscles. Often, it is of an acute onset with a preceding injury.

Sometimes, it occurs due to overuse of the shoulder, especially in athletes who participate in throwing sports. In non-athletes, there may be a history of recent heavy lifting.

The diagnosis is often obtained through a thorough history and physical examination.

Investigations such as x-rays, ultrasound scans, magnetic resonance imaging (MRI), or computed tomography (CT) scans may be done to assess its severity and/or exclude injuries to the surrounding structures. This will also help with selecting the appropriate course of treatment.

• ​Rest. Active rest is the main treatment for rotator cuff tendinopathy.
  
• Medication. Paracetamol and nonsteroidal anti-inflammtory drugs (NSAIDs) can also reduce pain and inflammation.
  
• Physiotherapy. Physiotherapy to regain strength and motion is also a modality of treatment.
  
• Steroids. Occasionally steroid injections may be performed to reduce the inflammation in the rotator cuff tendons if rest, medication or physiotherapy does not help.
  
• Shockwave therapy. In calcific tendinopathy, extracorporeal shockwave therapy (ESWT) may be delivered to the affected tendon to help with the pain.
  
• Surgery. Surgery is sometimes needed in large or complete rotator cuff tendon tears, and may involve enlarging the space underneath the acromion and repair of the rotator cuff tendon.