TENDINITIS

ROTATOR CUFF
Anatomi Rotator Cuff
Primary Function
Muscle Origin on Scapula Insertion on Humerus

Superior Facet of Greater

Supraspinatus Supraspinous Fossa  Abduction
Tuberosity

Middle Facet of Greater

Infraspinatus Infraspinous Fossa  External Rotation
Tuberosity

Lateral Border of Inferior Facet of Greater

Teres Minor External Rotation
Scapula Tuberosity

Lesser Tuberosity of
Subscapularis Subscapular Fossa Internal Rotation
Humeral Neck
Tendinitis rotator cuff

■ Rotator cuff tendonitis is an inflammation of the tendons

that make up the rotator cuff, i.e., supraspinatus,
infraspinatus, teres minor, and subscapularis. This is best
evaluated using radiographs (Grashey view) and managed
using physical therapy, medical and surgical
interventions. 
Symptoms

The symptoms or characteristics of rotator cuff tendinopathy are pain in

the area of the four rotator cuff tendons and tenderness located in the
shoulder-joint with a dull character, especially with overhead reaching,
reaching behind the back, lifting, and sleeping on the affected side. More
relevant in elevation of the shoulder and abduction, unable to reach higher
than 90° abduction, anteflexion of the upper arm. The ADL can cause quite
a bit of pain. The pain is not sudden but will gradually increase and is been
there for some time. Associated with pain is the growing weakness of your
shoulder and inability to move.[14] [15] There could also be a local swelling.
Specific Tests

■ Empty can test

■ Hawkin’s Test
■ Drop arm test
■ External rotation lag sign
Self-managed exercise program:

Week 0: Baseline assessment & start of treatment

Resisted isometric shoulder abduction (or lateral rotation or flexion etc) against a wall, or
resisted shoulder abduction from 0°-30° using moderate resistance from Theraband.
Week 3-4: initial follow-up & progression
Resisted shoulder abduction from 80 to 120° using light weight, e.g. tin of food.
Week 6-8: Second follow-up & progression
Resisted shoulder abduction from 80 to 120° with progressively increasing repetition and
weight, e.g heavy Theraband or dumbbell.
Week 10-12: Final follow-up & discharge
Final assessment to identify any non-resolved functional limitations and progress loaded
exercises as required, e.g. press-up, pull-up.
Kasus:

■ Pasien datang dengan keluhan nyeri pada bahu kanan sejak 2-3 minggu lalu. Aktivitas
terakhir olahraga upper body di gym menggunakan beban dan keesokan harinya terasa
kurang nyaman di bahu sebelah kanan. Sudah pernah fisioterapi 4x dan membaik tetapi
masih ada gejala sisa. Nyeri yang terasa hanya nyeri local dan tidak menjalar. Ada
riwayat cedera bahu kanan sekitar 2-3 tahun lalu. Nyeri terasa Ketika mengangkat
lengan ke belakang.
Hasil pemeriksaan:

■ Nyeri tekan pada tendon rotator cuff dextra

■ Nyeri terasa saat kontraksi isometric abduksi, adduksi,eksorotasi,endorotasi
■ Tightness m.pectoralis dextra
■ Spasme upper trapezius dan rhomboid major dextra
■ VAS =5
■ Forward head posture
■ Tidak ada limitasi ROM
■ Tidak ada inflamasi
Treatment:
■ Hot pack
■ Ultrasound
■ Muscle release + massage gun
■ Flexibility exc
■ PNF strengthening
■ Ekso-endo strengthening
■ Chin tuck
■ Wall push up
■ Core exc
■ Stretching (upper trap, rhomboid, pectoralis)
■ TENS