Rotator Cuff Tendinopathy / Tendinitis
Rotator cuff tendinopathy is commonly referred as rotator cuff tendinitis. The rotator cuff is comprised of four different muscles that are located around the shoulder and help in maintaining good stability of the shoulder joint. The four muscles blend together on the outside aspect of the shoulder to form a tendon that attach to the bone. The term tendinitis (which means inflammation of a tendon) has been medically questioned when describing rotator cuff tendon problems as it has been shown scientifically that inflammation is rarely present in cases of shoulder pain due to rotator cuff tendon issues and if present it rarely lasts longer than a week. The term tendinopathy (which means a problem of the tendon) is preferred because it encompasses two conditions affecting the tendon: inflammation of the tendon (tendinitis) and degeneration of the tendon (tendinosis). Both conditions present with very similar symptoms but the latter being much more common than originally thought. Rotator cuff tendinopathy is more commonly caused by overuse, repetitive movements of the shoulder and/or poor posture than trauma. In any cases, when the rotator cuff tendon gets irritated it can produce inflammation or degeneration of the tendon which results in the common symptoms of rotator cuff tendinopathy.
Common Symptoms of Rotator Cuff Tendinopathy / Tendinitis
- Pain and local tenderness in the shoulder and/or along the side of the arm
- Difficulty to move the shoulder, for example moving it above the shoulder level or behind the back
- Loss of shoulder and arm strength
- Muscle tension
Treatment of Rotator Cuff Tendinopathy / Tendinitis Using the McKenzie Method/MDT in Montreal
Proper treatment of rotator cuff tendinopathy requires determining the true source of the symptoms. At Active Solution Physiotherapy in Montreal we know that there are three main possibilities (neck, shoulder joint and shoulder tendon) that need to be examined to determine the true cause of these symptoms in each case. The McKenzie Method of Mechanical Diagnosis and Therapy (MDT) uses a systematic approach to properly classify the source of your rotator cuff tendinopathy / tendinitis.
The Neck and Upper Back in Rotator Cuff Tendinopathy / Tendinitis
Pain diagnosed as rotator cuff tendinopathy / tendinitis can be coming from the neck and/or upper back. Just as sciatica can send pain down the leg, the neck can cause pain in the shoulder and the arm. Pressure on the nerves of the neck can cause direct pain in the shoulder and/or the arm without necessarily causing neck pain. It can also cause changes in the functioning of the nerve which can impact the tissues around the shoulder. It is important to determine if the neck and/or upper back are factors in your case as many persistent rotator cuff tendinopathy problems have a cervical (neck) and/or upper back components that have never been identified. At Montreal's Active Solution Physiotherapy a scientific “cause-and-effect” assessment procedure will clearly demonstrate the presence or absence of these components to your rotator cuff tendinopathy. Neck and/or upper back exercises, posture and mobilisations may be used to treat a relevant spinal component to your pain and rapid improvements are often seen within the initial 1-2 sessions.
Joint Problems in Rotator Cuff Tendinopathy / Tendinitis
A mechanical problem in the shoulder joint can also be the primary cause of pain in the outside aspect of the shoulder and/or arm. Many different structures have been identified in the shoulder joint that could cause a mechanical disruption to normal movements, meaning that something may be getting caught in the joint and impeding normal movement. It has been observed for decades that movements (mobilisations / manipulations) of the shoulder can cause rapid changes in the symptoms of patients with rotator cuff symptoms. At Montreal's Active Solution Physiotherapy shoulder movement exercises and mobilisations may be used to treat this type of problem and rapid changes are normally seen within the initial 1-2 sessions.
Tendon changes in Rotator Cuff Tendinopathy / Tendinitis
The third common source of problems in patients with rotator cuff tendinopathy / tendinitis is changes in the tendon in itself. These can occur as a result of a gradual accumulation of micro-trauma (from overuse) or from an acute trauma. When this type of cause has been identified (including thorough testing which has eliminated the neck, upper back and shoulder joint as causes of your symptoms), Montreal Active Solution Physiotherapy's treatment will focus on very specific stretching and/or strengthening exercises using an established protocol that has shown good results. Improvements are slower in this category of rotator cuff problem and normally require two weeks to be evident.
There are other possible sources of rotator cuff tendinopathy / tendinitis symptoms. The McKenzie Method/MDT assessment can also identify other less common sources of shoulder pain and treat them accordingly.