SPORTS INJURIES
Rotator Cuff Tendonitis and Impingement
Syndrome
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. (Matsen, F. "Shoulder overview." Feb
1997.
http://www.orthop.washington.edu/bonejoint/zrzzzzxz1_2.html. 09/14/98)
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. 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.
These problems generally respond well to arthroscopic surgery, however, in our
opinion, the best 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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