Shoulder Tendinopathy Flashcards
What is Shoulder Tendinopathy?
Shoulder tendinopathy refers to irritation, inflammation, or degeneration of the tendons in the shoulder, particularly those of the rotator cuff. It leads to pain, weakness, and difficulty with overhead movements.
What Causes Shoulder Tendinopathy?
Repetitive overhead activities, poor posture, muscle imbalances, or sudden increases in activity can overload the tendons, leading to microtears and irritation. It’s common in athletes and people with repetitive arm use in work or hobbies.
Which Tendons Are Commonly Affected?
The tendons of the rotator cuff—supraspinatus, infraspinatus, teres minor, and subscapularis—are most commonly involved. The supraspinatus tendon, which helps lift the arm, is particularly prone to tendinopathy.
Why Are These Tendons Vulnerable?
The rotator cuff tendons pass through a narrow space between the shoulder blade and the humerus.
Repetitive movements or poor biomechanics can lead to irritation and impingement in this area.
What is the Recovery Process Like?
Recovery requires reducing irritation and gradually strengthening the tendons. Tendons heal slowly, so consistency with exercises is key to seeing progress over weeks or months
Key Observations and Movements to Assess
- Observe posture and scapular positioning (e.g., rounded shoulders or winging scapula).
- Assess range of motion (active and passive) in the shoulder, particularly abduction and external rotation.
- Palpate the shoulder to identify tender points over the rotator cuff tendons.
- Test for strength and pain with resisted movements.
Tests to Identify Shoulder Tendinopathy
- Hawkins-Kennedy Test
Assesses for impingement in the shoulder.
Stand next to patient’s bad shoulder. Shoulder F at 90°, bring your arm under theirs and put you hand on their oposite shoulder and your other hand on top of their wrist (of the elevated arm), push the arm down. Pain indicates possible supraspinatus tendinopathy.
- Neer’s Test
Stand behind patients back (they are sitting) Arm is externaly rotated and passively elevated overhead. Pain suggests subacromial impingement, often associated with tendinopathy.
- Empty Can Test
Make patient to lift their arms at 90 shoulder flexion, opened widely, rotated inwards, thumbs pointing at the floor. Make them to resist the pressure you apply on their wrists. Pain or weakness if the affected arm comapared to the non-affected points Subacromial Pain Syndrome.
- External Rotation Strength Test
Tests infraspinatus function. Patient is sitting on chair, you stand behind their shoulder, make to bend their elbow, hold their elbow and with the other hand their wrist, and open their arm out at external rotation. Instruct the patient to actively hold the external rotation, while you realising the wrist, providing only support at the elbow. A positive sign is if there’s lag/drop of the arm. Full Thickness Rotator Cuff Tears
Early-Stage Exercises for Shoulder Tendinopathy
- Isometric Shoulder Abduction - Against wall with elbow bend at 90, pushing at towel for more comfort.
- Scapular Squeezes Purpose: Improves scapular positioning and reduces shoulder strain.
How to Perform: Squeeze the shoulder blades together and hold for 5 seconds. Repeat 10-15 times. - External Rotation with a Resistance Band. Purpose: Strengthens the infraspinatus and teres minor.
How to Perform: Attach a resistance band to a fixed point. Keep your elbow bent at 90°, and rotate your arm outward. Perform 2-3 sets of 10-12 reps.
What Empty Can Test indicates?
Pain but no weakness strongly suggests supraspinatus tendinopathy or partial tear.
Differentiation: A full rupture typically presents with significant weakness.
What suggests a Pain at End Ranges of PROM
Suggests tendon irritation under load or compression.
Consistent with a tendinopathy.
What do night pain and tenderness in the bicipital groove suggest?
Potential biceps tendinopathy or SLAP lesion. A SLAP lesion, or SLAP tear, is a tear in the shoulder’s labrum, the fibrocartilage that lines the shoulder socket.
What is subacromial bursitis?
Inflammation of the bursa under the acromion. It can cause pain in the shoulder, but is less likely without significant swelling or restricted range of motion.
What is subacromial pain syndrome?
A broader term that encompasses various conditions, including tendinopathy, bursitis, and impingement syndrome.
What is the recommended treatment for early-stage shoulder pain?
Avoid aggravating activities: Reduce repetitive overhead movements.
Maintain gentle mobility: Avoid immobilization to prevent stiffness.
Educate the patient: Explain the nature of tendinopathy as an overuse injury and the importance of gradual loading.
Explain to the patient the conceps of pain and load management
Let’s work together to get your shoulder feeling better.
First, let’s give your shoulder a break. Try to avoid activities that cause pain, like reaching high shelves or playing tennis. We want to give your shoulder a chance to rest and heal.
But, don’t let it get stiff! If you don’t move it, the joints can start to stiffen up, now this is something we want to avoid. “We to find the balance. Your shoulder needs time to recover. But at the same time, if you don’t do anything, there’s a risk of it getting stiff and developing frozen shoulder. So, the best approach is to start with gradual strengthening.
Exercise stimulates the production of collagen, the protein that makes up tendons. This helps repair damaged tissue and promote healing. As the tendon becomes stronger, it becomes less irritated and painful. Exercise also increases blood flow to the tendon, which helps deliver oxygen and nutrients to the healing tissue. Stronger muscles can help to support and protect the tendon, reducing strain on it. By gradually increasing the load on the tendon, you can help it heal properly and prevent future injuries.”
