Rotator Cuff Tendinopathy

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Presentation transcript:

Rotator Cuff Tendinopathy

Normal Anatomy

Pathology Continuum of changes to the tendon Can progress to end stages which result in a tear within the tendon

Mechanism Of Injury Intrinsic Extrinsic Age Related Changes Vascularity Tendon Matrix Anatomical Scapular Kinematics Humeral Head Kinematics

Mechanism Of Injury - Intrinsic

Mechanism Of Injury - Intrinsic

Mechanism Of Injury - Extrinsic

Mechanism Of Injury - Extrinsic

Mechanism Of Injury - Extrinsic

Pathology and Stages

Associated Pathologies Internal Impingement External Impingement

Subjective Reactive Disrepair Degenerative 50 + Continued overloading Acute overload caused by a change in load, environment or equipment Chronically unloaded and weakened tendon Increased pain with activity Persistent pain Night pain Non- specific pain Continued overloading with incomplete rest for healing Increased pain with activity Persistent pain Night Pain Non- specific pain 50 + Continued overloading Symptoms indicative of a partial or full thickness tear Night pain Can be pain free

Objective Reactive Disrepair Degenerative Global restriction in range of movement Swollen or globally thickened tendon Global pain throughout tendon Difficult to differentiate with reactive Pain end of range movement Passive range of movement greater than active range of movement Pain and weakness on resisted testing if a tear is present Focal tenderness on palpation May be completely pain free

Objective – The Shoulder Symptom Modification Procedure Thoracic Kyphosis Scapular Position Scapular Winging Humeral Head Procedures Neuromodulation Procedures

Further Investigation Ultrasound MRI

Conservative - Management

Conservative - Management Reactive Relative Rest Unload the tendon Degenerative Load the tendon Be aware of a potential tear Correct surrounding dysfunctions

Surgical - Management Arthroscopic Repair Mini Open Repair Open Repair Subacromial Decompression