Shoulder Rotator Cuff Tendinitis and Bursitis

ROTATOR CUFF TENDINITIS (Supraspinatus Tendinitis)

Rotator cuff tendinitis is an inflammation of one or more of the muscle tendons that hold the ball of the shoulder joint tightly against the socket. Usually it affects the tendon of the supraspinatus muscle. Supraspinatus tendinitis, as it is properly known, is one of the most frequent causes of shoulder pain.  This tendinitis condition usually occurs in conjunction with an impingement syndrome.

Symptoms:

• Onset of symptoms is gradual.
• Pain and weakness during shoulder motion, especially when the arm is extended straight when
  raised and lowered between 80 and 120 degrees.
• Localized tenderness and sometimes swelling at front and upper part of the shoulder.
• In severe cases, the arm cannot be raised to shoulder height.

Causes:

• Powerful, repetitive overarm motions.
• Sudden increase in the frequency, intensity, or duration of the training or playing regimen.

Concerns:

• If neglected, rotator cuff tendinitis can deteriorate to the point where long layoffs and intense
  rehabilitation are necessary to correct the condition.
• Conservative treatment may not work.  Surgery may be the only way the athlete can return to sports.
• Rarely do athletes who require surgery regain their pre injury form.
  
  

What you can do:

• As soon as the symptoms of rotator cuff tendinitis surface, ice the shoulder three times daily for
  twenty to thirty minutes a day. A bag of frozen peas or corn works well.
• Continue to be active, but modify the overarm activity so it does not cause pain. If pain persists,
  cease the activity.
• Begin a conditioning program to stretch and strengthen the rotator cuff muscles and return to
  sports in six weeks, but only when pain and range of motion have returned.
• If symptoms persist for more than two weeks, seek medical attention.
  
  

Medication:

• For relief of minor to moderate pain, take acetaminophen as directed on label.
• For relief of pain and inflammation, take ibuprofen or aspirin if tolerated.
  
  

What the doctor can do:

• Take a detailed medical history and perform a careful physical examination to confirm diagnosis.
• Direct the athlete to curtail or cease activities that caused the condition.
• Usually, non-surgical treatment is sufficient to clear up rotator cuff tendinitis:
  • RICE (Rest/Ice/Compression/Elevation)
  • Anti-inflammatories
  • Cortisone injections
• The cortisone will take forty-eight hours to relieve the tendinitis symptoms. Because of the
  weakening effect of cortisone, the athlete should not perform dynamic activity using the shoulder
  for two weeks. Cortisone usually takes thee weeks to clear up the tendinitis. Even when the
  tendinitis remains chronic, no more than three cortisone injections are advisable because the
  drug may dangerously weaken the tendon.
• Surgery may be necessary when the tendinitis is so severe it does not respond to conservative
  treatment. The goal of surgery is to make more room for the tendon by removing the coracoacromial
  ligament, trimming off calcifications of the acromion of the shoulder blade, and excising the nearby bursa.
  If the tendons are significantly torn, the tears should be stitched together during the operation.
  Once a major surgical procedure, this operation is now done on an outpatient basis.  Some Rotator cuff
  repairs can even be done with just an arthroscopic procedure.
• When no stitching is done during surgery, isometrics and physical therapist- assisted range-of-motion
  exercises can start as soon as pain allows -- usually twenty-four to forty-eight hours after the operation.
  Strength training with weights and active range-of-motion exercises can begin in three to five days.
  
  

Recovery time:

• If caught early, one to three weeks of shoulder activity modification and rehabilitation exercises are
  enough to clear up the condition.
• If the tendinitis deteriorates to where it is moderately severe, it may take up to six weeks of rest and
  rehabilitation for the condition to heal.
• After surgery, six to twelve weeks of rest and rehabilitation is needed before returning to sports, and at
  least twelve weeks before starting activities that require vigorous use of the shoulder.
  

SHOULDER BURSITIS (Subacromial Bursitis, Calcific Bursitis)

Shoulder bursitis is an irritation and swelling of the bursa sac that lies between the rotator cuff tendons and the shoulder blade.
This form of bursitis rarely occurs in isolation. The condition is usually brought on by impingement syndromes or damage to the rotator cuff tendons. In athletes older than thirty to thirty-five, it may be precipitated by calcium deposits that have developed around the rotator cuff tendons, which irritate the bursa and sometimes actually enter the bursa sac.

Symptoms:

• Onset of symptoms is gradual.
• Pain in the front and upper part of the shoulder.
• Pain when performing the same motions as in the 'Symptoms' section of 'Shoulder Tendinitis', above.
• Loss of motion.
• Localized tenderness and swelling over the bursa.

Causes:

• Repetitive overarm motions that trap the subacromial bursa between the rotator cuff tendons and the
  underside of the shoulder blade.
• Sudden increase in the frequency, intensity, or duration of training or playing regimen.
• Inflammation of the rotator cuff tendons, especially the supraspinatus tendon.
• Calcific tendinitis of the supraspinatus tendon that causes irritation to the bursa sac.
  

Note: Shoulder bursitis may be caused by a single blow to the shoulder that causes bleeding into the bursa. In such cases it is an acute injury.

What you can do:

• Depending on pain, curtail or cease the activity that caused the condition, but do not render
  the shoulder completely inactive as this can cause frozen shoulder.
• Apply ice immediately for twenty to thirty minutes at a time, as often as possible for three days.

Medication:

• For relief of pain and swelling, take acetaminophen as directed on label.
• For relief of pain and inflammation, take ibuprofen or aspirin if tolerated.

What the doctor can do:

• Take the medical history and perform a physical examination to confirm the diagnosis.
  Sometimes arthography, bursography, and/or MRI are done to assist with the diagnosis.
• Direct the athlete to curtail or cease activities that caused the condition.
• Usually, conservative treatment is sufficient to clear up shoulder bursitis:
  • Anti-inflammatories
  • RICE (Rest/Ice/Compression/Elevation)
  • Heat treatment
  • Draining the bursa with a syringe
  • Steroid injections into the bursa sac (followed immediately by
    rehabilitation exercises to restore strength an mobility)
  • In severe cases, immobilize the shoulder in a sling or splint for
    a few days, but no longer than this, as prolonged immobilization
    can cause frozen shoulder.
• If conservative measures fail, surgery may be necessary. Bursa sac is removed with an arthroscope
  or through a small incision. Usually, the coracoacromial ligament is also removed during this operation.
• If the bursitis is caused by associated conditions such as torn or calcified rotator cuff tendons, these
  conditions are surgically addressed.
• After surgery, the arm is immobilized in a sling for ten days.

Rehabilitation:

• As soon as the first symptoms of bursitis are felt, level two rehabilitation exercises should start.
• After surgery, level one range-of-motion exercises should begin within seven days.  Level two exercises
  should begin two weeks after surgery.
• For levels one, two, and three rehabilitation guidelines, refer to the sections on rehabilitation and
  conditioning at the end of this chapter.
  

Recovery time:

• With appropriate treatment, mild to moderate shoulder bursitis conditions clear up in two to three weeks.
• After surgery, six to eight weeks of rehabilitation before athletes can return to full sports activity.

Reprinted with permission from The Sports Medicine Bible (HarperCollins), by Dr. Lyle J., former President of the American College of Sports Medicine