What is Rotator Cuff Tendinopathy?

The shoulder is composed of a complex structure of bone, joint, muscles, and tissues that work together to provide a wider range of movement than any other joint in the body. In particular, the rotator cuff connects the upper arm bone to the shoulder blade. It also ensures that the ball of the upper arm bone is firmly held in the shoulder socket.

Shoulder pain, however, can develop often when the smooth movement around the rotator cuff is obstructed. A thorough examination of the affected area and history of pain is necessary in order to manage pain, treat possible injury or rotator cuff tendinopathy and restore normal joint movement.

What is rotator cuff tendinopathy?

The rotator cuff consists of tendons which help the arm perform functional tasks such as lifting, raising and pulling movements. The normal rotator cuff tendon ordinarily functions without pain. Within the tendon are water and collagen which facilitate tendon movements of stretching and compressing. As one end the tendon is stretched, the other end is compressed. This type of movement, however, can cause stress within the tendon, making it susceptible to injury.

Remodelling of tendon tissues:

Tendon tissues normally go through a constant cycle of degradation and rebuilding also known as remodelling. Remodelling chemicals that are released in order to process repair of damaged tissues are inflammatory and pain-mediating. The larger the tear at the rotator cuff, the higher the concentration of these pain-inducing chemicals at the injured area.

Possible causes of rotator cuff tendinopathy?

Several factors such as overloading can lead to rotator cuff tendinopathy. Overloading occurs when the rotator cuff tendon is subjected to activity beyond the normal capacity of the tendon. A normal rotator cuff tendon can withstand brief overload without causing pain and will eventually return to its previous state.

Problems can arise when the increased pressure at the tendon causes a corresponding volume increase under the acromion or the outermost point of the shoulder blade that can lead to the development of spurs. An inflamed rotator cuff (tendonitis) may fail to control movement at the ball joint of the shoulder which may further irritate tendon fibres.

Over time the remodelling chemicals or MMPs gradually decline leading to tendon degeneration. At this stage, the rotator cuff tear may not heal even with surgery. Other causes that can contribute to tendinopathy include tendon compression, underuse, genetics, and nutrition.

Rotator cuff tendinopathy is a complex shoulder condition that is best treated with stage appropriate advice, pain management and exercise strategies to help improve tendon remodelling and prevent advanced disrepair.

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