Rotator Cuff Tendinopathy, diagnosis and management
The definitive cause of RC tendinopathy remains uncertain, as does the reason for the pain experienced by people with this common condition. It has been suggested that even underloading may disrupt tendon homeostasis, potentially resulting in a temporally earlier point of failure, when the tendon is subject to load. Also central sensitization could contribute to explain this disparity, and several studies have investigated its role in individuals with RC tendinopathy.
The aim of this commentary is to present information related to the function of the RC, to discuss uncertainties related to pathoetiology and assessment, and to present strategies for management based in part on a specific approach to shoulder symptom modification proce- dures (SSMPs) outlined herein.
The first procedures of the SSMP aim to determine the influence of increasing and decreasing the thoracic kyphosis on the presenting symptoms.
If the thoracic procedures do not or only partially alleviate symptoms, then symptom changes secondary to scapular procedures are assessed.
If the scapular procedures do not fully alleviate symptoms, the clinician progresses to assess the effects of the humeral head procedures.
The primary intervention for treating RC tendinopathy is active exercise therapy.
Surgery does not confer additional benefit at 1-, 2-, or 5-year follow-up for the treatment of RC tendinopathy.
Education and lifestyle need to be addressed as part of the treatment of RC tendinopathy. With respect to education, patients need to understand what has happened to the tendon and shoulder, why it has happened, and the impor- tance of a structured exercise program.
A video of Jeremy Lewis talking about shoulder diagnosis and rehabilitation and SSMPs:
> From: Lewis et al., J Orthop Sports Phys Ther (2015) 13(Epub ahead of print). All rights reserved to The Journal of Orthopaedic & Sports Physical Therapy. Click here for the Pubmed summary.