Rotator Cuff Tendonitis & Bursitis

The rotator cuff is a group of four muscles that become tendons as they attach on the head of the humerus. The rotator cuff functions to stabilize the shoulder and allow for motions including raising the arm forward and rotating the arm in and out.

The acromion is part of the scapula or shoulder blade. When the arm is elevated the space for the rotator cuff tendons between the acromion and humeral head is decreased and can create contact. In some people with different shaped acromion’s, such as those with a bone spur, this can result in inflammation and pain.

The rotator cuff tendon has a protective fluid sac known as a bursa that protects the tendon from contact with the acromion. Inflammation of the bursa is known as bursitis.

Tendonitis and bursitis often develops slowly over time and without an obvious cause. It may happen with overhead or repetitive activities or more immediately after a single event.

The most common symptom is pain with activity or sleeping on that side at night. Symptoms can also include an ache in the arm above the elbow or into the neck and back.

Evaluation includes a history of symptoms, a physical examination, x-rays for bone spurs or arthritis, and specialized physical exam maneuvers. Specialized maneuvers are used to help distinguish tendonitis from rotator cuff tears. An MRI may be done to determine a partial from a full thickness rotator cuff tear.

Treatment is based on examination, imaging, and pain. Initial treatment is aimed at reducing pain and starts with anti-inflammatory medications and physical therapy to reduce inflammation and strengthening to reduce future recurrence. A corticosteroid injection into the shoulder is used in those who do not get better with initial treatment. In those who’s symptoms persist despite the above treatment, arthroscopic shoulder surgery to decompress the space around the rotator cuff may be done. In this case, without a rotator cuff tear, the shoulder can be used just a few days after surgery.