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  • 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


A 20-year-old right hand dominant male college student who recently started painting houses for his summer employment. He reports working 5 consecutive days painting primarily with his right arm for 10+ hours each day. He subsequently developed progressive pain in the anterior/lateral aspect of his shoulder and had difficulty using his right arm for work activities. In addition, he reports currently experiencing pain reaching behind his back to tuck in his shirt, and with any reaching out to the side which is impacting his ability to perform his normal ADLs. He consulted with his PCP who started him on an oral NSAID and referred him to PT. Some of his examination findings include pain provocation with resisted isometric lateral rotation, and abduction, positive Neer and Hawkins Kennedy Impingement signs, and tenderness to palpation over the greater tuberosity. His cervical range of motion is WNL and Spurlings test is negative. In addition, his drop arm and external rotation lag signs were negative.



  • 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.

FIGURE 156-1

Rotator cuff tear. MRI coronal image of the shoulder reveals a tear in the supraspinatus tendon (arrow) with edema (arrowhead). (From Tintinalli JE, Stapczynski JS, John Ma O, et al. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 7th ed. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

FIGURE 156-2

Examination of the shoulder joint. (A) Topography of the shoulder. The bony prominences ...

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