ROTATOR CUFF TENDINOPATHY

Saad Khan
200101054
 CASE VIGNETTE 1

Patient name Mr.Robert, 45 Year old, a recreational tennis player presents with c/o gradual
onset of right shoulder pain over the past 6 months, worsening with overhead activities.
There is no history of trauma. Pain aggravated by serving in tennis and lifting objects
overhead. Associated night pain that disrupts sleep

On Physical Examination:
• Tenderness over the greater tuberosity
• Painful arc of motion from 60 to 120 degrees of abduction
• Positive Hawkins-Kennedy and Neer impingement signs
• Weakness in abduction and external rotation
 Overuse Injury in a Middle-Aged Athlete
DIAGNOSIS
 CASE VIGNETTE 2

Patient name Mr.Denver, 72 Year old, retired engineer, involved in Regular swimming and
light weightlifting, presents with c/o Chronic left shoulder pain and weakness over the past
year, progressively worsening.
No specific injury. Pain aggravated by swimming and lifting weights. Difficulty with
activities of daily living, such as combing hair and dressing.
On Physical Examination:
• Tenderness at the anterior aspect of the shoulder
• Positive impingement signs (Neer and Hawkins-Kennedy)
• Weakness in abduction and external rotation, positive drop arm test
 Chronic Degenerative Tendinopathy
DIAGNOSIS
in Active Seniors
 WHAT IS ROTATOR CUFF?

The Rotator Cuff is a common name for the

group of 4 distinct muscles and their tendons that
provide strength and stability during motion of
the shoulder.
 ROTATOR CUFF TENDENOPATHY

•Chronic condition characterized by pain and dysfunction due to

degenerative changes or inflammation of the rotator cuff tendons.

•Tendonitis / Tendinitis - Inflammation of the tendon.

•Tendinoses- Degenerative condition- Tendon damage at cellular level.
•Tendinopathy = Tendonitis + Tendinoses
 PATHOPHYSIOLOGY

• - Tendon Overload: Microtrauma due to repetitive overhead

activities
• - Degeneration: Age-related changes leading to tendon
weakening and tearing
• - Vascular Supply: Compromised blood supply contributing to
poor healing
 •Etiology
• - Intrinsic Factors: Tendon degeneration, aging, poor
vascularity
• - Extrinsic Factors: Repetitive motion, impingement
syndrome, trauma
ETIOLOGY AND •Risk Factors
RISK FACTORS • - Age >40 years
• - Occupations involving overhead activities
• - Sports participation (e.g., baseball, swimming)
• - Poor posture and scapular dyskinesis
 CLINICAL PRESENTATION

•Symptoms
• Pain: Anterolateral shoulder pain, exacerbated by overhead
activities
• Weakness: Difficulty with lifting and rotational movements
• Night Pain: Often disrupts sleep
•Signs
• Tenderness: Over the greater tuberosity
• Positive Impingement Tests: Neer, Hawkins-Kennedy
• Range of Motion: Limited abduction and external rotation
 DIAGNOSIS AND
INVESTIGATIONS

•Clinical Assessment
• Comprehensive History: Onset, duration, activity-related pain
• Physical Examination: Inspection, palpation, range of motion, special
tests- Empty Can Test, Hawking’s Test

•Imaging Studies
• X-rays: Assess bony abnormalities and acromial morphology
• MRI: Gold standard for soft tissue evaluation, tendon integrity
• Ultrasound: Dynamic assessment, cost-effective
DIFFERENTIALS OF SHOULDER
PAIN

• Adhesive Capsulitis (Froz • Complex Regional Pain S

en Shoulder) yndromes
• Biceps Rupture • Osteoarthritis
• Bicipital Tendinopathy • Rheumatoid Arthritis
• Cervical Disc Disease • Shoulder Pain in
• Cervical Spondylosis Hemiplegia

• Cervical Sprain and • Thoracic Outlet Syndrom

e (TOS)
Strain
TREATMENT
OPTIONS