Rotator Cuff Tendinopathy: What is it?
Rotator Cuff Tendinopathy is defined as pain and weakness, most commonly experienced with movements of shoulder external rotation and elevation, as a consequence of excessive load on the rotator cuff tissues. The etiology of rotator cuff tendinopathy is multifactorial and can be attributed to extrinsic and intrinsic mechanisms, as well as to environmental factors. Rotator cuff tendinopathy is not a homogenous entity because of the diverse nature of the factors involved and hence, different treatment interventions are required, which take these specific mechanisms into account. The Rotator Cuff is a common name for the group of 4 distinct muscles and their tendons that provide strength and stability during movement of the shoulder.
Cause of Rotator Cuff Tendinopathy
The definitive cause for Rotator Cuff Tendinopathy remains uncertain but there are proposed mechanisms include intrinsic, extrinsic or combined factors
There are different Risk factors: Awkward Postures, Static Postures, Heavy Work, Direct Load Bearing, Repetitive Arm Movements, Working with hands above shoulder height, Lack of Rest.
How can physiotherapy help treat Rotator Cuff Tendinopathy?
The aim of physiotherapy is to introduce a management programme aiming to reduce pain and swelling of the tendons. A focus on range of motion and progressive strengthening is completed.
Initially ice should be utilised aiming to reduce inflammation causing pain. It is important at the beginning that the patient avoids activities that increase pain and symptoms. The physiotherapist should guide the patient on when to resume these activities again.
Physiotherapists use a variety of techniques to assist in increasing range of movement and strength: such techniques include deep tissue massage, trigger point release, acupuncture and manual therapy. A stringent exercise programme is also provided for the patient to abide to.
What Physiotherapy treatments assist (that Physiotherapy offers mostly and Cortisone/Corticosteroid injections otherwise if applicable)
The use of non-steroidal anti-inflammatory drugs (NSAID’s) such as ibuprofen can assist in reducing the inflammation. Secondly a corticosteroid can be commonly administer for the treatment of tendon disorders. The effect of subacromial corticosteroid injection is sustained by the available evidence. Although the effect may be small and short-term. Further, the injection of platelet-rich plasma also proves to be effective for significant improvement on pain, function and pain outcomes.
Exercises to consider:
A detailed exercise programme specific to the individual is provided at a physiotherapy appointment.
Stretching and range of motion exercises:
- pendulum exercise: bend forward and dangle a fully extended arm at shoulder height 90° from the body, posterior capsule stretching: reach with your affected arm across your body and use the other arm to pull the affected arm closer to your body. 2. scapular squeezes
- Mobilisation exercise with a cane: At the beginning of the training programme, patients may have a lack of range of motion. An actively assisted motion may, for instance, be performed with a cane. It is important that the exercises are performed within the pain limits.
Start position: The patient lies on his back, with bended knees, on the table with the cane in his two hands. He puts his unaffected arm at the bottom of the cane and the affected arm at the top. Exercise: The patient moves the cane with his unaffected arm. He brings his affected arm slowly upwards and downwards and repeats the exercise 25 times. (Elevation and depression) Other movements: external rotation and abduction. Upon external rotation the patient also lies on his back on the table with a cane in his hands. The elbows are bend in ninety degrees. Just like in the other exercise, it’s the unaffected arm that moves the other arm in external rotation.
- Resistance training is utilised to increase the flexibility of the joint and thus reduce the tension placed on the rotator cuff. It is proven that resistance training can be used to increase mobility. It was also proved that improving strength was associated with an improvement of other factors, namely: muscle and bone mass and balance.
- Strength training is considered when the patient demonstrates adequate passive and active glenohumeral range of motion, absent substitution patterns, with acceptable scapulothoracic kinematics