Causes of Rotator Cuff Tendinopathy and Investigations

Causes of Rotator Cuff Tendinopathy

Tendinitis

- When a muscle is stressed due to overuse, microscopic tears occur.

• And because of tears, inflammation occurs as a result of healing.
• However, if the healing is not allowed to occur due to the same activity, inflammation becomes chronic.
• Chronic Inflammation then causes progressive damage to tendons, causing them to be less elastic.
• Hence they become more susceptible to tearing.

Rotator Cuff Tear

• Tears mainly involve supraspinatus tendon.
• Tears can be acute, which are typically present with sudden onset of pain and dysfunction due to trauma.
• Chronic tears are present for longer than 3 months and may be associated with variable degress of weakness and comfort.
• Tears can be of varying in degree.
• Mainly due to overhead motions.*

Impingement Syndrome

• Caused by the impingement of the the 4 muscle tendons under the subacromial space.
• Called so because there’s a space under the arch of the acromion.
• With repetitive pinching with movement, the tendon(s) can get irritated and become inflammed, causing pain.
• Neer described 3 stages of impingement syndrome existing as a continuum eventually leading to rotator cuff tearing.

stage 1 : subacromial oedema and haemorrage present

stage 2 : fibrosis and tendinitis present

stage 3 : rotator cuff failure resulting in partial/complete tearing of tendon

• 2 Types of impingement : External and Internal
• External Impingement : Primary and Secondary

Primary : Impingement is caused by irregular shaping of acromial arch.

: Can be congenital or degenerative changes *.

Secondary : Impingement is caused by poor stabilisation of the scapular, altering
the position of the acromion, making it causing impingements.*

• Internal Impingement : Occurs mainly in athletes

: Under side of rotator cuff gets impinged against the glenoid
labrum , hence causing pain. *

Investigations

X- Rays

- Can only be done to rule out bone dislocation or fracture

• Can also show presence of calcium deposits or bone spurs.
• However they do not show soft tissues in the image

Magnetic Resonance Imaging

• MRI’s use magnetic waves and computers to make detailed images of the interior of the shoulder
• Can show small and even partial tears of tendons.

Athroscopy

• An incision is made on the shoulder, and inserts a small camera into the cut area
• Allows physician to see whether the rotator cuff is torn.
• However, not really done due to it’s invasive nature.