Rotator Cuff Tendonitis

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Rotator cuff tendonitis might not sound familiar to you because it has a variety of other names, including pitcher's shoulder, swimmer's shoulder and tennis shoulder. But even if you're not a pitcher, you don't swim or you've never played tennis, rotator cuff tendonitis can affect you. Several factors, like sudden injury or trauma, can lead to this condition, meaning everyone is at risk.

The main symptom of rotator cuff tendonitis is debilitating pain in the shoulder. It usually begins gradually, when patients are using their arm in everyday activities. Later, the pain may travel to the upper arm and elbow, sometimes worsening at night. Ultimately, those suffering from rotator cuff tendonitis find that the pain is so intense they can't move their arm the way they used to.

The culprit is the rotator cuff, a group of muscles and their associated tendons that form a sleeve around the shoulder joint. These tendons connect the muscles to the bones in the shoulder, allowing the arm to move up, move down, stabilize and rotate.

The problem starts when the tendons become inflamed, as a result of an injury, repeated overhead arm movements (like reaching for a high object) or the ordinary wear and tear of everyday life. In younger, more active people, falls and sports-related injuries are usually the cause. For less active older people, the tendons are usually already weakened, making them more susceptible to tears during normal activity.

If you have rotator cuff tendonitis, it's important to see a healthcare practitioner as soon as possible. The condition can lead to shoulder impingement syndrome, a more serious problem that can severely restrict your shoulder's range of motion. Adequate care offers many safe, conservative and effective methods of relieving pain and reducing inflammation.

Anatomy

The simple act of moving your arm is actually a very complex process involving an assortment of muscles, tendons, ligaments and bones. All of them play a crucial role in the way the arm and shoulder function.

The rotator cuff comprises four muscles called the supraspinatus, the infraspinatus, the subscapularis and the teres minor. These muscles surround the joint, much like the cuff of a shirt sleeve surrounds the wrist. Together with tendons, which attach muscle to bone, these muscles rotate and stabilize the humerus (the upper arm bone).

The rotator cuff doesn't work alone, however. It works with the deltoid, a major muscle in the shoulder that lifts the arm. When the deltoid pulls the arm up, the rotator cuff pulls down, much like a tug-of-war.

This also prevents the head of the upper arm bone from rolling out of its socket, called the glenoid fossa. The glenoid fossa is fairly shallow, allowing the arm to move freely in a number of directions. Because it's shallow, however, it doesn't provide enough depth to stabilize the upper arm bone, making the rotator cuff crucial for holding the bone in place. Without the muscles and tendons pulling it down, the humerus would become too mobile and dislocate.

After injury, repeated lifting of heavy objects or everyday wear and tear, the tendons in the area can get stretched or torn, leading to inflammation and eventually rotator cuff tendonitis. Repetitive overhead arm movements can also cause problems, as lifting the arm upward gives the tendons and the bursa (a protective sac in the socket) less room to move around. This causes friction among the tissues, making them irritated and more prone to inflammation.

If you have rotator cuff tendonitis, your chiropractor will assess your shoulder to determine the stage, severity and cause of your condition. Once he or she has established these specifics, you can begin an appropriate care and rehabilitation program.

Chiropractic Care

Every patient with rotator cuff tendonitis is unique, so if you have the condition, your chiropractic care will depend on the stage, severity and specifics of your case. Once your chiropractor has performed a thorough assessment, he or she will select from a number of management options to help in the management of your injury.

One important technique he or she might use is spinal manipulative therapy, also called an adjustment, which is a technique involving quick, strategic thrusts to stiff or hypomobile joints with either the hands or a device called an activator tool. If you have rotator cuff tendonitis, joints in your neck and upper back can get stiff from the pull of tight muscles that attach from the shoulder to the neck, as well as from everyday postural strains. Adjustments can help to restore proper motion to these joints and enable the spine and nervous system to function optimally. Once the joints are functioning properly, it will in turn help relax your tight muscles.

Physiotherapeutic devices like ultrasound and interferential current (IFC) are also helpful. Ultrasound refers to any sound wave that has a frequency above the range the human ear can perceive. To produce these waves, chiropractors use a machine that channels electricity through a crystal located at the end of an applicator. The crystal vibrates in response to electricity, and the machine allows users to alter the electrical current to affect the waves' frequency. Depending on the frequency, this can increase blood flow, decrease pain, reduce muscle spasm, lessen nerve root irritation, break down scar tissue and speed healing.

IFC is very similar, but employs an electrical current instead of sound waves. IFC machines work by sending this current through the skin into nerve fibers below, which causes the body to produce endorphins, its natural painkillers. By aiming the impulses at the shoulder, chiropractors can cause endorphins to interrupt the flow of pain signals from the affected tissues to the brain.

Your chiropractor may also perform mobilizations, which involve passively moving the joint through its proper range of motion. To perform this, he or she will raise, lower and rotate your arm, which stretches tissue, increases blood flow to the muscles and broadens the arm's range of motion.

At home, rest and ice are your best allies. Rest will allow your shoulder to heal and ice will constrict blood vessels and reduce blood flow to surrounding muscles, decreasing painful inflammation. If your shoulder is not too sore, however, you should try to maintain some movement, even if it's just by swinging your arm like a pendulum. This will lessen your risk of getting adhesive capsulitis, a more serious condition that can develop when damaged tissue has a chance to settle in immobile shoulder joints.

Your chiropractor may also give you some sleeping and postural advice. If, for example, you sleep with your arm tucked under your pillow, you could be straining and damaging your shoulder. Likewise, try to avoid overhead arm movements, because when you raise your arm the space between the top of your humerus (upper arm bone) and acromium (the high part of the shoulder) gets smaller, pinching the tendons in between and leading to inflammation.

Once your condition has started to heal, it's important that you aim to improve the strength of your rotator cuff muscles by performing stretches, light resistance exercises and aerobic activities. Your chiropractor can tell you when your shoulder is ready for exercise, and prescribe some exercises to help. Some of these may be functional exercises, which target the muscles you use in everyday activities. Others may be proprioceptive exercises, which retrain your muscles to be coordinated and function in the proper order.

In most cases, conservative chiropractic care can effectively manage rotator cuff tendonitis. In some cases where there are significant tears in the rotator cuff muscles, however, chiropractors refer patients to a medical doctor, who might recommend surgery.

Regardless of the management plan, it's important that you don't take your subsequent pain-free movement for granted. The shoulder is a complicated body part and needs appropriate rehabilitation. Various bones, joints, muscles and tendons can all contribute to problems in the shoulder, either directly or indirectly, and for the shoulder to work properly you must make the appropriate lifestyle changes to ensure all these parts are healthy.

Rotator Cuff Tendonitis

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