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 Tears 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.