Rotator Cuff Tendinitis

Treatment Of Rotator Cuff Tendinitis

Shoulder pain and weakness complaints among patients of different age groups are frequently caused by rotator cuff injuries. Your rotator cuff is a set of four tendons and four small muscles in your shoulder that help you lift and rotate your arm. Its most important function is to control the gliding of the humeral head under the acromial arch when lifting the arm. Rotator cuff tendons can be damaged due to various reasons such as acute injury, overuse in professional activities and sports, and poor shoulder position due to poor posture.

Rotator cuff tendon disease, refers to injuries of two different types: tendinitis and tendinosis, which should not be confused, as they have different natures and require different treatment approaches. Rotator cuff tendinitis refers to injury accompanied by inflammation, while tendonisis is tendon damage at the cellular level. Tendinosis is frequently misdiagnosed as tendinitis. Tendinosis is characterized by changes in the collagen matrix, increased cellular and vascular activity, and lack of inflammation, which is the primary marker for tendinitis. Proper diagnosis is important for identifying tendinopathy type and prescribing adequate treatment.

Since tendon degeneration does not involve inflammation, it does not respond to anti-inflammatory medication.

Why Rotator Cuff Tendinopathies Occur

Acute pain in the rotator cuff often manifests during an abrupt movement, like lifting a heavy weight, forcefully throwing an object, or falling on the arm or shoulder. Pain often appears after overloading the shoulder muscles during exercise, especially when using poor technique or lifting excessive weight. Rotator cuff tendinitis is common in sports, especially in baseball pitchers, tennis players, swimmers and kayakers. Atrophy of the rotator cuff from lack of exercise and shoulder movement can cause tendinosis because of muscle imbalances that cause abnormal gliding of the humeral head and wear and tear of rotator cuff tendons. This also applies to poor shoulder position while sitting at a desk or driving all day.

Why rotator cuff tendinopathies occur

Symptoms of Rotator Cuff Tendinopathy

Symptoms of rotator cuff tendinosis are pain in the front or side of the shoulder which spreads to the side of the arm, and difficulty in lifting the arm or reaching behind the back. The pain often gets worse as the activity continues. Many patients cannot sleep on the injured shoulder due to pain. A popping or cracking sensation and general weakness are signals to visit a doctor.

Treatment Options

One treatment option for rotator cuff tendinosis is platelet-rich plasma (PRP) injections. Blood plasma enriched with platelets stimulates the healing of bone and soft tissues. However the efficacy and safety of PRP have not been proven on a large scale due to inconsistent results in many clinical trials. PRP treatment is dependent on the quality of plasma, and determining an appropriate dosage poses a problem. PRP treatment may have side effects, including increased pain in the treated area or intense discomfort in the muscle or bone. There is the possibility of infection, regardless of sterilization.

Physical Therapy

Conventional treatment for rotator cuff tendinosis involves various rehabilitation exercises for strengthening the rotator cuff. Our preferred approach is Dynamic Neuromuscular Stabilization (DNS), which involves precise positioning of the shoulder blade and humerus in specific developmental positions, with the goal of optimizing rotator cuff muscle and shoulder girdle function. Proper movement is restored and pain arising from the position of the humeral head beneath the acromial arch disappears. While traditional physical therapy focuses on strengthening the rotator cuff muscles, we first seek to restore motor control and muscular synergies, prior to muscle strengthening exercises. The core of DNR is Dynamic Neuromuscular Stabilization, an effective system of exercise originating from the famous Prague School of Physical Rehabilitation. This revolutionary European treatment is suitable for all ages and physical conditions, and has proven highly effective in treating neuromuscular problems.

Our preferred approach is Dynamic Neuromuscular Stabilization (DNS)

ESWT (Extracorporeal Shockwave Therapy)

Extracorporeal shockwave therapy is a treatment method used for multiple tendonopathies that regenerates degenerated areas of the tendon by growing new micro blood vessels. This biological process is called neovascularization. It is a safe and effective method that excludes the risk of infection and formation of scar tissue. ESWT is performed only after ultrasound or MRI diagnostics.

The procedure eliminates pain and restores full mobility. The beneficial effects of ESWT usually appear after only four treatments. Some patients experience immediate pain relief.

ESWT (Extracorporeal Shockwave Therapy)

Our Approach

As the first clinic to apply the DNS method in the US, New York Dynamic Neuromuscular Rehabilitation Center presents the most modern and comprehensive rehabilitation approach. The effectiveness of DNS method in treatment of rotator cuff injuries is marked by the fact that many professional tennis and baseball players use DNS shoulder pain therapy and DNS exercises for post-traumatic rehabilitation and prevention. One of the first DNS practitioners in the US, Dr. Kalika serves as injury prevention consultant for top professional tennis players. However, the application of DNS therapy does not restrict its effectiveness to sports medicine, and DNS is equally suitable for all patient groups. Successfully combining DNS with physical therapy, chiropractic methods and rehabilitation techniques, and using the most advanced equipment, we help people recover from and prevent neuromuscular pain.

Redcord Neurac Therapy:
Suspension Training Meets Physical Therapy for Rehab, Fitness and Performance
Your body is a masterpiece of form and function, designed to move in fluid and coordinated patterns governed by your nervous system. But oftentimes, overuse, underuse or abuse of your muscular system can result in pain, injury, uncoordinated movement and poor performance. Thankfully, through proper training and rehabilitation, your miraculous body is able to heal and recoup its natural functional capacity.
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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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