ROTATOR CUFF TENDONITIS
AND IMPINGEMENT SYNDROME Ross
Hauser, M.D.
Rotator cuff tendonitis occurs when the small muscles of the rotator cuff, the
supraspinatus, infraspinatus, teres minor, and subscapularis, become strained
causing weakness of these structures and subsequent
tendonitis. While the
deltoid muscle is the big and strong muscle of the
shoulder, as seen on many
well-built athletes, the small and relatively weak rotator cuff muscles perform
key functions. The supraspinatus helps seat the humeral head (ball) into the
glenoid cavity (socket) when the arm is raised from the side (abducted). The
infraspinatus and teres minor rotate the forearm away from the body or in the
hand-waving position (external rotation), and the subscapularis rotates the
forearm towards the body (internal rotation). Once the balance between motion
and joint stability is altered through weakness in the static structures
(ligaments) or the dynamic structures (rotator cuff muscles), pain and impaired
function will invariably ensue. Baseball pitchers, quarterbacks, tennis players
(serving), and swimmers are prone to rotator cuff tendonitis and impingement
syndrome. This is because these athletes perform a lot of overhead movements.
The rotator cuff is most vulnerable in this position.
Impingement syndrome occurs when the rotator cuff tendon becomes pinched between
the humeral head, on which it is attached, and the overhanging
acromion process,
when the arm is raised above the head. This happens when
the space becomes narrowed, as occurs when the rotator
cuff muscles weaken and the humeral head rides high in
the socket or when
bone spurs and calcium deposits
narrow the space. Impingement also occurs when the contents of the subacromial space
increase in size, most often due to a swollen rotator cuff tendon or bursa,
which is painfully squeezed between the humeral head and the acromion process.
MRI (Magnetic Resonance Imaging), which is an expensive test to look at the
rotator cuff, often does not help in evaluation and management. The condition
can easily be diagnosed by a physician who elicits a positive impingement sign.
Common treatment for rotator cuff tendonitis and impingement syndrome by
traditional medical doctors includes rest, non-steroidal anti-inflammatory drugs
(NSAIDS),
physical
therapy, and
cortisone injections into the subacromial space.
Because a cortisone injection has very strong anti-inflammatory properties, it
may reduce the swelling in the tendon and bursa, relieving the symptoms. These
treatments may temporarily help, but since the underlying cause has not been
addressed the problem invariably returns. Degenerative fraying and tearing of
the tendon may occur if constant irritation of the tendon occurs from the
impingement process over time. In my opinion, the best way to treat this unresolved process is
with
Prolotherapy injections to the ligaments and tendinous insertions of the
rotator cuff and deltoid. This, combined with gradual re-strengthening of the
rotator cuff muscles, give an excellent chance for a full recovery and
performance.
Anyone who has been told they have rotator cuff tendonitis should consult with a
Prolotherapy doctor.
In my opinion the best treatment approach is early recognition and treatment with Prolotherapy. In this scenario, Prolotherapy is encouraged, as it eliminates the
need for a lot of
shoulder surgeries. If the rotator cuff tear has become large
enough to produce profound weakness in the shoulder, shoulder surgery may be
necessary and Prolotherapy can be used as a post-operative treatment to improve
tissue strength and overall recovery.
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ROTATOR CUFF TENDONITIS
AND IMPINGEMENT SYNDROME