Rotator cuff tendonitis

• Supraspinatus tendonitis
• Infraspinatus tendonitis

• 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

• S43.429A Sprain of unspecified rotator cuff capsule, initial encounter
• S43.80XA Sprain of other specified parts of unspecified shoulder girdle, initial encounter

• 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With Localized Inflammation

Description

• 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.

Essentials of Diagnosis

• 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.

General Considerations

• The rotator cuff stabilizes and steers the head of the humerus in the glenoid of the scapular at the glenohumeral (GH) joint.
• Rotator cuff and possibly the biceps are thought to compresses the head of the humerus into the glenoid to ...