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Condition/Disorder Synonyms

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  • Supraspinatus tendonitis

  • Infraspinatus tendonitis

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ICD-9-CM Codes

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  • 726.10 Disorders of bursae and tendons in shoulder region, unspecified

  • 840.3 Infraspinatus (muscle) (tendon) sprain

  • 840.4 Rotator cuff (capsule) sprain

  • 840.5 Subscapularis (muscle) sprain

  • 840.6 Supraspinatus (muscle) (tendon) sprain

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ICD-10-CM Codes

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  • S43.429A Sprain of unspecified rotator cuff capsule, initial encounter

  • S43.80XA Sprain of other specified parts of unspecified shoulder girdle, initial encounter

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Preferred Practice Pattern1

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Key Features

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Description

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  • Inflammation, irritation, swelling of one or more of the rotator cuff tendons

    • Supraspinatus muscle

    • Infraspinatus muscle

    • Teres minor muscle

    • Subscapularis muscle

  • Occurs most often from repetitive motion injuries or impingement syndrome but can occur with a sudden strain/stress to the tendon.

  • Early stages: The tendon becomes swollen and red, and as the tendonitis develops, the tendon sheath may thicken

  • Late stages: Chronic inflammation may result in fraying of the tendon (tendinosis) and could progress to rupture with long term inflammation.

  • Shoulder pain and dysfunction due to compression and abrasion of one or more of the rotator cuff tendons

  • Impingement is the most commonly diagnosed shoulder problem and likely has numerous potential mechanisms, which can impact both treatment and prognosis.

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Essentials of Diagnosis

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  • Multifactorial and thought to be related to intrinsic and/or extrinsic mechanisms.

    • Extrinsic mechanisms (extratendinous, caused by decreased sub-acromial space and subsequent micro-trauma with repetitive movements)

      • Mechanical wear under the coracoacromial arch

      • Aberrant movement patterns due to rotator cuff and/or periscapular muscular dysfunction

      • Capsular abnormalities

        • Capsular tightness (particularly posterior capsule)

        • Capsular laxity (poor humeral head dynamic control)

      • Sub-optimal posture

        • Muscle imbalances

      • Overuse/repetitive motions occurring at more than 90 degrees of elevation

    • Intrinsic factors (directly associated with the narrowing of the sub-acromial space)

      • Vascular supply/changes to the cuff tendons

      • Acromial morphology (structural variations)

        • Type I (flat)

        • Type II (curved)

        • Type III hooked)

      • Degenerative and/or structural changes to the AC joint

      • Other trophic changes in the coracoacromial arch or humeral head

  • Classification

    • Primary impingement is usually associated with degenerative changes to any of the following tissues:

      • Rotator cuff tendons

      • Acromioclavicular (AC) joint

      • Coracoacromial arch

    • Secondary impingement is the result of muscle imbalances and/or joint instability, which can result in altered dynamics and subsequent secondary impingement.

    • A third class of impingement, not subacromial in nature, is referred to as internal impingement and occurs between the undersurface (articular side) of the rotator cuff tendons and the posterior/superior surface of the labrum in the position of abduction and external rotation that occurs with throwing.

    • Regardless of the specific classification, all types of impingement are proposed to be mechanisms of rotator cuff and biceps tendinopathy.

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General Considerations

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  • The rotator cuff stabilizes and steers the head of the humerus in ...

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