Rotator cuff tendinopathy

Rotator cuff tendinopathy is a painful and debilitating condition that affects the tendons and muscles of the rotator cuff in the shoulder. This condition is common and can range in severity from mild inflammation to more serious tendon injury.

Diagnosis of rotator cuff tendinopathy involves a comprehensive clinical evaluation and, in some cases, imaging tests. Here are the key aspects of the diagnosis:

The doctor will begin by obtaining a detailed medical history of the patient. This will include questions about the nature and duration of shoulder pain, activities that trigger or aggravate symptoms, and any previous shoulder injuries.

During the physical examination, the doctor will evaluate the shoulder for signs of tendinopathy. This may include testing strength and mobility, as well as identifying areas of tenderness in the affected tendons.

Imaging tests, such as x-rays, ultrasounds, or magnetic resonance imaging may be performed to evaluate the structure of the tendons and surrounding tissues.

Rotator cuff tendinopathy can manifest in a variety of ways, and patients may present with different phenotypes or patterns of presentation. Here are some common phenotypes:

  • Acute Tendinopathy: In this variant, tendinopathy develops suddenly due to a traumatic injury or excessive strain. The pain can be severe and is accompanied by swelling and weakness in the shoulder.
  • Chronic Tendinopathy: Chronic tendinopathy is usually the result of gradual wear and tear of the tendons due to age, repetitive activity, or lack of physical conditioning. Symptoms may develop slowly over time and may include persistent pain, weakness, and limitation of function.
  • Partial or Complete Rupture: In some cases, tendinopathy can progress to a partial or complete rupture of one or more rotator cuff tendons. This can cause more severe symptoms and may require a different treatment approach.
  • Calcification: Some patients may develop calcium deposits in the tendons of the rotator cuff, known as calcific tendinitis. This can cause acute pain and limited mobility.
  • Referred Symptoms: Sometimes shoulder pain due to rotator cuff tendinopathy can refer to other areas, such as the neck or arm. This can make accurate diagnosis difficult.

Treatment:

Treatment of rotator cuff tendinopathy depends on the specific phenotype, severity of the condition, and the individual needs of the patient. The most common treatment options are described below:


Conservative Management:

  • Rest and Limitation of Activities: In acute cases, rest and limitation of activities that aggravate symptoms are essential.
  • Physical therapy: Strengthening and stretching exercises supervised by a physical therapist can help improve strength and flexibility in the shoulder.
  • Physical Therapy Modalities: Ultrasound therapy, shock wave therapy, and other physical therapy modalities can relieve pain and promote healing.

Medicines:

Nonsteroidal anti-inflammatory drugs (NSAIDs)can relieve pain and reduce inflammation in mild to moderate cases.

In some cases, corticosteroid injections may be given directly to the affected area to reduce inflammation and relieve pain.

Platelet Rich Plasma (PRP) Therapy has been used in some cases. This therapy involves injecting a concentration of the patient's own platelets into the affected area to promote tissue regeneration.


Surgery:

In severe cases, when there is a complete rupture of the tendon or when other treatments have been unsuccessful, surgery may be necessary to repair the rotator cuff tendons. This may involve an open repair or arthroscopic surgery.