Rotator Cuff Tendonitis

Shoulder exercises to prevent rotator cuff tendonitis

Disorders of the rotator cuff and the tissues around it are the most common causes of shoulder pain in people over 40 years of age. Rotator cuff tendinitis occurs when a shoulder tendon (a bundle of fibers connecting muscle to bone) is irritated and becomes sore. With continued irritation, the tendon can begin to break down, causing tendinosis—a chronic, long-term condition. People who perform repetitive or overhead arm movements, such as weightlifters, overhead athletes, and manual laborers are most at risk for developing rotator cuff tendinitis. Poor posture can also contribute to its development. A physical therapist can help you identify and correct risk factors for rotator cuff tendinitis, and help you decrease your pain while improving your shoulder motion and strength.

What is Rotator Cuff Tendinitis?

The rotator cuff muscles are a group of 4 muscles that attach the humerus (upper-arm bone) to the scapula (shoulder blade). The rotator cuff muscles help raise, rotate, and stabilize the upper arm. A tendon is a bundle of fibers that connect the muscles to the bone. Rotator cuff tendinitis occurs when the tendon connected to the rotator cuff muscles becomes inflamed and irritated. It can be caused by:

  • Poor posture, such as rounded shoulders caused by leaning over a computer for long periods of time.

  • Repetitive arm movements, such as those performed by a hair stylist or painter.

  • Overhead shoulder motions, such as those performed by baseball pitchers or swimmers.

  • Tight muscles and tissues around the shoulder joint.

  • Weakness and muscle imbalances in the shoulder blade and shoulder muscles.

  • Bony abnormalities of the shoulder region that cause the tendons to become pinched (shoulder impingement syndrome).

How Does it Feel?

Rotator cuff tendinitis is characterized by shoulder pain that can occur gradually over time or start quite suddenly. The pain occurs in the shoulder region and sometimes radiates into the upper arm. It does not usually radiate past the elbow region. You may be symptom free at rest or experience a mild, dull ache; however, pain can be moderate to severe with certain shoulder movements. Reaching behind the body to perform a motion, as in fastening a seat belt, can be very painful. So can overhead activities, such as throwing, swimming, reaching into a cupboard, or combing your hair. The pain can worsen at night, especially when rolling over or attempting to sleep on the painful side. You may notice weakness when lifting and reaching for household items. Holding a heavy platter or taking a pan off the stove may become difficult.

How Is It Diagnosed?

A physical therapist will perform an evaluation and ask you questions about the pain and other symptoms you are feeling. Your therapist may perform strength and motion tests on your shoulder, ask about your job duties and hobbies, evaluate your posture, and check for any muscle imbalances and weakness that can occur between the shoulder and the scapular muscles. Your physical therapist will gently touch your shoulder in specific areas to determine which tendon or tendons are inflamed, and special tests may need to be performed to determine this.

How Can a Physical Therapist Help?

It is important to get proper treatment for tendinitis as soon as it occurs. A degenerated tendon that is not treated can begin to tear causing a more serious condition. Physical therapy can be very successful in treating rotator cuff tendinitis, tendinosis, and shoulder impingement syndrome. You will work with your physical therapist to devise a treatment plan that is specific to your condition and goals. Your individual treatment program may include:

Pain management. Your physical therapist will help you identify and avoid painful movements to allow the inflamed tendon to heal. Ice, ice massage, or moist heat maybe used for pain management. Therapeutic modalities, such as iontophoresis (medication delivered through an electrically charged patch) and ultrasound may be applied.

Manual therapy. Your physical therapist may use manual techniques, such as gentle joint movements, soft-tissue massage, and shoulder stretches to get your shoulder moving again in harmony with your scapula.

Range-of-motion exercises. You will learn exercises and stretches to help your shoulder and shoulder blade move properly, so you can return to reaching and lifting without pain.

Strengthening exercises. Your physical therapist will determine which strengthening exercises are right for you, depending on your specific condition. You may use weights, medicine balls, resistance bands, and other types of resistance training to challenge your weaker muscles. You will receive a home-exercise program to continue rotator cuff and scapular strengthening, long after you have completed your formal physical therapy.

Patient education. Posture education is an important part of rehabilitation. For example, when your shoulders roll forward as you lean over a computer, the tendons in the front of the shoulder can become pinched. Your physical therapist may suggest adjustments to your workstation and work habits.

Functional training. As your symptoms improve, your physical therapist will help you return to your previous level of function that may include household chores, job duties and sports- related activities. Functional training can include working on lifting a glass into a cupboard or throwing a ball using proper shoulder mechanics. You and your physical therapist will decide what your goals are, and get you back to your prior level of functioning as soon as possible.

Can this Injury or Condition be Prevented?

Rotator cuff tendinitis can be prevented by:

  • Maintaining proper shoulder and spinal posture during daily activities, including sitting at a computer.

  • Performing daily stretches to the shoulder and upper back to maintain normal movement. Tightness in the upper back, or a rounded shoulder posture will decrease the ability to move your torso, and that makes the shoulder have to work harder to perform everyday activities, such as reaching for objects.

  • Keeping your upper body strong, including the upper back and shoulder-blade muscles will help prevent tendinitis. Many people work the muscles in their chest, arms, and shoulders, but it is also important to work the muscles around the shoulder blade and upper back. These muscles provide a strong foundation for your shoulder function. Without a strong foundation, muscle imbalances occur and put the shoulder at risk for injury.

Shoulder inflammation can be painful, and should be taken care of. It is common among swimmers, or sports where arm swings and shoulder rotation are used consistently.The rotator cuff consists of four muscles and tendons that cover the head of the humerus and attach it to the shoulder blade, or scapula. They provide stability and strength during rotational movements in the arm. Shoulder impingement refers to mechanical compression or inflammation of the rotator cuff tendons. This occurs when the space in the shoulder joints narrows and the rotator cuff tendons or bursa, lubricating sacs located over the rotator cuff, become compressed, irritated or damaged, resulting in pain, inflammation and reduced mobility. Exercises that target the rotator cuff will strengthen the surrounding muscles and tendons, improve circulation to the joint, flexibility and range of motion.

External Rotation

Stand with your back against a wall, ensuring that your torso and shoulders remain straight. Bend your right elbow to form a 90-degree angle and bring your arm across your abdomen, remembering to keep your thumb upright and flattening your palm against your stomach. Perform an external rotation by moving your arm and forearm away from the abdomen, remembering to keep your elbow bent. Continue this external rotation until the back of your arm is flat against the wall. Hold this position for five seconds and rotate your arm back to the starting position. Perform one set of 10 repetitions on both arms, once daily. A more advanced alternative is side laying with a towel roll under the arm and performing a 90 degree angle ( between arm and forearm) external rotation with a light weight ( 2#), work on 3 x 10 as tolerated.

Supraspinatus Stretch

Standing upright, place the involved forearm behind the back with a gentle motion, try to maintain a straight angle between the arm and the forearm and the back of the hand in full contact with your lumbar area. If possible slide higher the hand closer to the tip of the shoulder blade. Hold a comfortable stretched position for about 45 seconds, repeat three times.

Empty Can Side Elevation

Stand upright and bring an extended arm to the side at about 45 degrees ( scapular plane ), keep your thumb pointing up and hold a light weight ( 2#)  reach as high as you are able, try to complete the motion with the arm close to the side of the face. A nice goal is to complete 3 sets of 15 repetitions. Make sure a good positioning of the head, shoulders and upper back is maintained through the exercise.

Scapular Squeezes

Lie on your back and bend both knees. Plant your feet firmly on the ground and extend your arms away from your body, with palms up. While maintaining contact between the ground and your lower back, begin squeezing your shoulder blades together, downward and toward your spine. While performing this exercise, try to not shrug your shoulders and remember to relax your neck. As your perform this exercise, the lower muscles between your scapula should be contracting. Hold each shoulder blade squeeze for five seconds and relax. Perform one set of 20 repetitions three times a day to strengthen the muscles in the shoulders and prevent further injury.