1. Rotator Cuff Tendinopathy

2. Normal Anatomy

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

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

5. Mechanism Of Injury - Intrinsic

6. Mechanism Of Injury - Intrinsic

7. Mechanism Of Injury - Extrinsic

8. Mechanism Of Injury - Extrinsic

9. Mechanism Of Injury - Extrinsic

10. Pathology and Stages

11. Associated Pathologies
Internal Impingement
External Impingement

12. 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

13. 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

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

15. Further Investigation
Ultrasound
MRI

16. Conservative - Management

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

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