shoulder

Rotator Cuff Tendonitis

According to The Merck Manual:
Rotator cuff tendonitis (swimmer's shoulder, tennis shoulder, pitcher's shoulder, shoulder impingement syndrome) is a tearing and swelling of the rotator cuff (the muscles and tendons that hold the upper arm in the shoulder joint).

These tendons are often injured in sports that require the arm to be moved over the head repeatedly, such as pitching in baseball, lifting heavy weights over the shoulder, serving the ball in racquet sports, and swimming freestyle, butterfly, or backstroke. Repeatedly moving the arm over the head causes the top of the arm bone to rub against part of the shoulder joint and its tendons, tearing individual fibers. If the movement is continued , despite the pain, the tendon can tear or actually pull off part of the bone.

Shoulder pain is the main symptom. Initially, the pain occurs only during activities that require lifting of the arm over the head and forcibly bringing it forward. Later, the pain can occur even when the arm is moved forward to shake hands. Usually, pushing objects away is painful, but pulling them in toward the body isn't.

The diagnosis is made when specific movements, especially raising the arm above the shoulder, cause pain and soreness. Sometimes arthrograms (x-ray taken after a substance visible on x-rays is injected into the joint) can detect complete tears of the rotator cuff tendon, but they usually aren't sensitive enough to detect partial tears.

Treatment consists of resting the injured tendons and strengthening the shoulder. Exercises that invole pushing something away or raising the elbows over the shoulder should be avoided. However, upright rowing with free weights (by bending, not raising the elbows) and downward lat pulls on a weight machine, which exercises the latissimus muscle in the back and shoulders, can be continued if they aren't painful. Surgery is sometimes needed when the injury is particularly severe, the tendon is completely torn, or the injury does not heal within a year.

According to Harvard Medical School Family Health Guide:
Rotator Cuff Tear and Bursitis: The rotator cuff is a powerful quartet of muscles and tendons that attach your upper arm bone to the shoulder blade. These structures can be partially or completely torn. This occurs primarily in people over the age of 50, unless some unusual activity, such as pitching a baseball, puts constant stress on the cuff. Partial tears of the rotator cuff can be confused with subdeltoid bursitis, painful to lift your arm to a 60-degree angle. With a complete tear, you cannot lift your arm from your side. Surgery is recommended to repair the tear. Bursitis, on the other hand, causes pain when you lie on the affected shoulder or when pressing on a bursa.

Tendonitis and Capsulitis of the Shoulder: Tendonitis often occurs in the shoulder. The affected tendon or tendons may become inflamed from excessive use, such as repeated overhand arm movements or heavy lifting. Tendonitis may also follow an injury, such as a fall on an outstreched arm. Often it occurs without a clear reason. Tendonitis can occur at different spots in the shoulder, producing somewhat different symptoms. Capsulitis involves inflamation and shrinkage of the capsule of the shoulder. If capulitis becomes chronic, it can lead to the development of scar tissue, which transforms capulitis into adhesive capsulitis, where it hurts to lift your arm in any direction.

Symptoms: Both tendonitis and capsulitis produce pain and discomfort in your upper shoulder or the upper third of your arm. The pain may also radiate into your neck. You may be awakened from sleep by pain if you roll onto your shoulder. The factors that aggravate the pain are slightly different depending on which part of the shoulder is affected. Most often tendonitis involves the tendon on the top part of the shoulder (the supraspinatus muscle tendon) that runs under a cushioning sac called the subdeltoid bursa; the tendon can be pinched by the scapula (the triangular bone over the ribs) with certain movements. Pain from inflammation of the supraspinatus muscle tendon and subdeltoid bursa often come on suddenly and is felt at the outer part of the shoulder when you lift your arm, in the upper arm, and when someone presses down on the top outer part of your shoulder. Pain caused by the tendon of the biceps muscle also often comes on suddenly and is felt in front of the shoulder with certain motions and when someone presses where the biceps muscle tendon attaches to the bone. Capsulitis usually produces pain that comes on gradually. The pain is felt throughout the whole shoulder area and, in contrast to tendonitis, usually is not caused by pressing on a particular spot.

Treatment Options: Your doctor will recommend treatment similar to that for rotator cuff injury - rest, cold applications, and nonsteroidal anti-inflammatory drugs to relieve pain and inflammation. Gentle exercises can help restore full range of motion and use. If you have extreme pain, your physician may inject a corticosteroid medicine around the inflamed tendon. Knowing where to inject it involves making the right diagnosis. X-rays of the shoulder are not usually helpful in making the diagnosis.

Determining the Type of Shoulder Pain:

Torn Rotator Cuff: If your rotator cuff is torn, you will find it impossible to lift your arm to the 90 degree position. However, if someone helps you lift your arm up to the 90 degree position, you will be able to hold it there without help. Partial tears may cause pain and milder weakness.
Supraspinatus Tendonitis or Subdeltoid Bursitis: In supraspinatus tendonitis or subdeltoid bursitis, you will notice pain when you, or when someone helps you, lift your arm up to the 60 degree position. (Also, it will hurt if the top outer part of your shoulder is pressed.)
Adhesive Capsulitis: In adhesive capsulitis, it will hurt when you, or someone helps you, lift your arm in almost any direction.
Biciptal Tendonitis: In biciptal tendonitis, whenever you try to turn your hand it will hurt. (Also it will hurt when the area in front of the shoulder-where the biceps muscle tendon attaches to the bone - is pressed.