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TENDINITIS AND ROTATOR TEARS: SYMPTOMS AND EFFECTIVE THERAPIES

Do you know the symptoms of rotator cuff injuries and the difference between tendinitis and tears? Effective solutions for your shoulder.

Gabriele February

11 min. Dec 18, 2024

Tendinitis and Rotator Tears: Symptoms and Effective Treatments

Understanding Rotator Cuff Disorders

What is the Rotator Cuff?

The rotator cuff is a group of four muscles and tendons that surround the head of the humerus, helping stabilize the shoulder joint and allowing the shoulders a wide range of motion, along with the deltoid muscle. They are essential for every movement, from lifting a glass to throwing a ball.

Rotator cuff tears are relatively rare but significant among athletes, particularly in high-impact sports such as soccer. In elite soccer athletes, the shoulder has been identified as the fourth most common injury site, accounting for 10%–20% of all injuries. However, rotator cuff tears, both partial and full-thickness, are relatively rare in this population. Despite their rarity, these injuries can have a substantial impact on an athlete's career, with limited data available to guide players and team physicians on return-to-play (RTP) rates and clinical outcomes after sustaining a rotator cuff tear. The prevalence and impact of these injuries underscore the need for further research and insights in this area.

Rotator Cuff Functions and Importance to Movement

The rotator cuff muscles play a vital role in stabilizing and mobilizing the shoulder joint. Composed of the supraspinatus, infraspinatus, teres minor, and subscapularis, these muscles work together to facilitate various shoulder movements, including abduction, adduction, internal rotation, and external rotation. The supraspinatus initiates arm abduction, while the infraspinatus and teres minor contribute to external rotation. The subscapularis, on the other hand, is primarily responsible for internal rotation. Furthermore, the rotator cuff muscles work collectively to maintain the humeral head within the glenoid cavity during arm movements, providing stability and preventing dislocation.

The Crucial Role of the Rotator Cuff Unit in Movements

These functions are essential for the overall mobility and stability of the shoulder joint, highlighting the importance of the rotator cuff muscles in facilitating a wide range of upper limb motion.

Difference between Tendinitis and Rupture

Rotator tendinitis manifests as irritation or inflammation of the tendons, often caused by overload or overuse, and can cause pain and limited mobility. A rupture, on the other hand, indicates more serious damage, where the tendons are partially or completely torn, requiring more intensive treatment and sometimes surgery.

Signs Not to Ignore

Common Symptoms of Rotator Cuff Injury

Pain in the front of the shoulder and along the arm is the most common warning sign, especially at night. Be careful if lifting your arm or moving your shoulder causes sharp pain or you hear cracking sounds. These symptoms, whether progressive or immediate post-injury, should not be ignored.

When to see a specialist?

Don't wait if the pain persists, prevents you from sleeping, or limits your daily activities. Even more important, consult a shoulder surgeon if you experience an inability to move your shoulder or if you notice swelling and deformity. Prompt intervention prevents complications and promotes better healing.

Causes of Rotator Cuff Injuries

Risk Profiles: Athletes and Manual Workers

Athletes who play tennis, swim, or row, as well as manual laborers, constantly expose their shoulders to stress. The repetitiveness and intensity of their movements are factors that could jeopardize the health of their rotator cuffs. Knowledge and prevention become crucial strengths for them.

Aging and Natural Degeneration

As we age, tendon tissues lose elasticity and strength. This natural degenerative process increases the risk of rotator cuff tears, which are therefore not uncommon in people over 50. Add to this the wear and tear from daily activities, and a simple action can trigger the injury.

Treatment Options for Shoulder Pain

Conservative Therapy: Effectiveness Without Surgery

Conservative therapy aims to relieve pain and restore shoulder function without invasive surgery. It includes rest, slings, strengthening physiotherapy, and, if necessary, cortisone injections in very acute conditions or in older patients. Non-cortisone injections are preferable for younger patients. These measures are often sufficient to restore shoulder function in cases of tendinitis and small tears in older patients. In selected cases, hyaluronic acid or growth factor (PRP) injections may be considered, especially for those for whom NSAIDs are contraindicated.

Conservative therapy has shown promising efficacy for rotator cuff problems, as supported by research data. A systematic review and meta-analysis comparing conservative and surgical management of full-thickness rotator cuff tears found that, at a 2-year follow-up, clinical outcomes were comparable for both surgical and conservative treatment. Furthermore, at a 5-year follow-up, both groups showed improved clinical outcomes, with a significant increase in the Constant-Murley score (CMS) in the surgical group. However, at a 10-year follow-up, the clinical outcomes of patients undergoing surgical repair remained stable over time, while the clinical outcomes of patients treated conservatively declined, leading to the need for surgery in some patients. These findings suggest that conservative therapy may be effective in managing rotator cuff problems, providing results comparable to surgery, at least initially.

Surgery: When is it Necessary?

When conservative therapy fails or the tear is complete, surgery becomes necessary. Two factors primarily guide the surgical choice: persistent pain and functional impairment. Currently, this type of surgery is performed arthroscopically, except in very rare cases.

Shoulder arthroscopy is a minimally invasive surgical procedure used to diagnose and treat shoulder joint problems. Through small incisions (less than 1 cm), a small camera is inserted into the joint to visualize and, if necessary, repair damage such as rotator cuff tears. This technique allows for rapid healing and minimizes postoperative pain.

Recent studies have provided updated statistics on the success rates of arthroscopic rotator cuff repair, highlighting the positive outcomes associated with this procedure. A retrospective study of patients over 65 years of age undergoing arthroscopic rotator cuff repair demonstrated significant improvements in postoperative functional outcomes. The study reported statistically significant improvements in range of motion (ROM), Constant Murley Score (CMS), and tendon integrity at follow-up. Specifically, ultrasound assessment demonstrated tendon integrity (types I and II) in 75% of cases, indicating successful repair.

The success rate of this type of surgery is very high, but it depends strictly on the quality of the tissue being repaired and often also on the patient's age and the time elapsed between the tear and the repair. Specific guidelines, published by the Italian Society of Shoulder and Elbow Surgery (SICSeG), guide the management of this type of problem.

There is much debate in the literature and among "super-specialists" about the surgical techniques to use for rotator cuff repair. Without going into too much detail, it's important to note that in recent years, there has been significant advancement in the technology of the anchors used, and double-row suture techniques or equivalent (such as bridge sutures) are demonstrating their superiority in repair.

Prevention and Self-Care

Preventive Exercises to Maintain Rotator Health

Strengthening the rotator cuff is both preventative and therapeutic. Exercises such as rotations with resistance bands or dumbbells should be done regularly. Incorporate them into your routine two to three times a week. Also incorporate shoulder blade exercises. Maintaining good mobility and strength is an investment in shoulder health!

The best choice will always be to rely on an expert physiotherapist who can create an exercise routine for each specific case. However, this is not always possible. For several months, Dr. Vasario has been contributing to the creation of specific programs supported by scientific literature for shoulder pathologies in the OnePhysio project ( https://www.onephysio.it).

Preventive exercises have been shown to significantly reduce the risk of rotator cuff injury, underscoring the importance of incorporating them into your weekly routine.

Clinical studies have shown that subjects who regularly performed specific strengthening and stretching exercises targeting the rotator cuff muscles experienced a significant reduction in the incidence of rotator cuff injuries. These exercises not only improved the strength and flexibility of the rotator cuff muscles, but also helped improve shoulder stability and reduce the likelihood of overuse injuries.

Therefore, incorporating preventative exercises into your weekly routine can play a vital role in reducing the risk of rotator cuff injuries and promoting overall shoulder health.

Lifestyles to Protect Shoulder Joints

Adopting an active lifestyle and maintaining a healthy weight helps protect your shoulders. Remember to don't neglect warming up and cooling down before exercising. Correct posture, both standing and sitting, is essential. And don't forget to take breaks during repetitive activities.

A study of 525 participants examined the effect of posture on rotator cuff tears, regardless of symptoms. Participants were assessed for rotator cuff tears using ultrasound examinations and classified based on posture: ideal, kyphotic-lordotic, flat back, or swayback. Analyses compared differences between groups and identified factors related to injuries. The study highlighted the link between posture and shoulder health.

Advanced Diagnostics for Rotator Cuff

Clinical and Instrumental Tests for an Accurate Diagnosis

An accurate diagnosis relies on tests such as ultrasound or MRI, after a clinical evaluation. These tests detail the damage to the tendons and guide treatment. Movement tests such as the Jobe test and ERLS are also crucial. The combined results will paint a clear picture of the health of your tendons.

How to Interpret Test Results

Interpreting the results means correlating the instrumental findings with the reported symptoms and the clinical examination. The doctor will assess the degree of injury or inflammation and the residual muscle function. Furthermore, the instrumental tests must always be correlated with the symptoms and, above all, with the specialist's examination. Understanding these results helps determine the most appropriate treatment plan.

Regarding ultrasound, it is essential that the operator performing the exam be qualified and experienced in osteoarticular pathology; for example, they should not perform abdominal ultrasound. It is important that they compare the scan with the other, unaffected shoulder and perform dynamic tests to complement the simple ultrasound visualization.

As for MRI scans, the report is often not reliable and the images, preferably at high resolution of at least 1.5 Tesla, must be viewed by a shoulder surgery specialist.

Frequently Asked Questions (FAQ)

What Are the Early Signs of Rotator Cuff Problems?

Persistent shoulder pain, especially at night, arm weakness, and difficulty lifting objects are clear signs. If you experience these difficulties, consult a doctor.

Is it possible to recover from tendonitis without surgery?

Yes, many cases of tendinitis improve with rest, physical therapy, and non-invasive medical treatments such as injections.

What is the Post-Surgical Recovery Time?

It depends on the type of surgery: 3-6 months for arthroscopic repairs, up to a year for more extensive procedures. Strict adherence to the rehabilitation program is crucial.

How Can I Modify My Daily Activities to Prevent Further Damage?

Prioritize ergonomics, take regular breaks, and reduce repetitive motions. Consider ergonomic tools if necessary.

For further information please see the section dedicated to the rotator cuff in the section News and Research,

Further Frequently Asked Questions (FAQ) can be found in the FAQ section of the website.

Bibliography / References

  1. Blevins FT, Hayes WM, Warren RF. Rotator cuff injury in contact athletes. Am J Sports Med. 1996;24(3):263-267. doi: 10.1177/036354659602400303. PubMed
  2. Weiss LJ, Wang D, Hendel M, Buzzerio P, Rodeo SA. Management of rotator cuff injuries in the elite athlete. Curr Rev Musculoskelet Med. 2018;11:102-112. doi: 10.1007/s12178-018-9464-5. PMC
  3. Kaplan LD, Flanigan DC, Norwig J, Jost P, Bradley J. Prevalence and variance of shoulder injuries in elite collegiate football players. Am J Sports Med. 2005;33(8):1142-1146. doi: 10.1177/0363546505274718. PubMed
  4. Return to play after rotator cuff tear in National Football League athletes. ScienceDirect. Available from: https://www.sciencedirect.com/science/article/pii/S2666638323001081
  5. Gibbs DB, Lynch TS, Gombera MM, Saltzman MD, Nuber GW, Schroeder GD, et al. Preexisting rotator cuff tears as a predictor of outcomes in National Football League athletes. Sports Health. 2016;8(3):250-254. doi: 10.1177/1941738116636602. PMC free article
  6. Anatomy, Thorax, Scapula - StatPearls - NCBI Bookshelf. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538319/
  7. Rotator Cuff: Muscles, Tendons, Function & Anatomy. Cleveland Clinic. Available from: https://my.clevelandclinic.org/health/body/rotator-cuff
  8. Longo UG, Ambrogioni LR, Denaro V. Conservative versus surgical management for patients with rotator cuff tears: a systematic review and META-analysis. BMC Musculoskelet Disord. 2021;22(1):1-9. doi: 10.1186/s12891-020-03872-4. BMC Musculoskeletal Disorders
  9. Longo UG, Ambrogioni LR, Denaro V. Conservative versus surgical management for patients with rotator cuff tears: a systematic review and META-analysis. PubMed. Available from: https://pubmed.ncbi.nlm.nih.gov/33419401/
  10. Galasso O, Mercurio M, Gasparini G, Cosentino O, Massarini A, Orlando N, Castricini R. Arthroscopic rotator cuff repair in patients over 65 years of age: successful functional outcomes and a high tendon integrity rate can be obtained after surgery. JSES International. 2023. Available from: https://www.sciencedirect.com/science/article/pii/S2666638323002815
  11. Kuhn JE. Exercise in the treatment of rotator cuff impingement: a systematic review and a synthesized evidence-based rehabilitation protocol. J Shoulder Elbow Surg. 2009;18(1):138-160. doi: 10.1016/j.jse.2008.06.004. PubMed
  12. Koo SS, Nozawa M, Moser AD, Kaneko RM, Kvitne RS. The impact of faulty posture on rotator cuff tears with and without symptoms. J Shoulder Elbow Surg. 2015;24(6):e149-e150. doi: 10.1016/j.jse.2014.09.032. PubMed