Rotator cuff

Rotator Cuff Tendinitis

Most common shoulder condition. Supraspinatus affected in 90% of cases. Neer classification in 3 stages.

Rotator cuff tendinitis is the most common cause of shoulder pain, accounting for 65-70% of consultations for shoulder pain. The rotator cuff comprises 4 tendons: supraspinatus (most affected, 90%), infraspinatus, teres minor and subscapularis. The Neer classification describes 3 stages: I (edema/hemorrhage, < 25 years), II (tendinosis/fibrosis, 25-40 years), III (partial or complete tear, > 40 years). Etiological factors combine extrinsic causes (subacromial impingement, type III acromion morphology) and intrinsic causes (tendon degeneration, hypovascularity of the supraspinatus critical zone).

Characteristics

  • Lateral shoulder pain radiating to the deltoid, worsened by arm elevation above 60° (painful arc 60-120°). Night pain when lying on the affected shoulder.
  • Jobe test (empty can test) for supraspinatus: elevation at 90° in internal rotation against resistance → pain and/or weakness. Patte test (external rotation against resistance) for infraspinatus.
  • Ultrasound: first-line examination (sensitivity 87-92% for complete tears). MRI if diagnostic doubt or pre-operative assessment (evaluation of retraction and fatty degeneration).
  • Muscular fatty degeneration (Goutallier classification on MRI) is a major prognostic factor. Stage ≥ 3 (> 50% fat) is associated with poor outcome after surgical repair.

Medical and surgical management

  • Stage I-II (tendinosis without tear): conservative treatment. NSAIDs, subacromial corticosteroid injection (max 3/year), physiotherapy 3-6 months. Success rate 60-80%.
  • Symptomatic partial or complete tear: arthroscopic repair with resorbable anchors (single row, double row suture). Early passive mobilization under sling protection.
  • Massive irreparable tear (retraction + fatty degeneration): reverse shoulder replacement if > 65 years, or tendon transfer (latissimus dorsi, lower trapezius) if < 65 years.

Physiotherapy rehabilitation

  • Dynamic re-centering of the humeral head: strengthening of depressors (infraspinatus, teres minor, subscapularis, latissimus dorsi). Key technique in impingement shoulder rehabilitation.
  • Eccentric rotator cuff work: protocol in external rotation and flexion. Progression from isometric to isotonic then eccentric.
  • Correction of scapular dyskinesis: lower trapezius and serratus anterior strengthening. Restore posterior scapular tilt during arm elevation.
  • Postural correction: reduction of thoracic kyphosis and shoulder protraction. Pectoralis minor stretching. Workplace ergonomics.

Average duration

6 to 16 weeks

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Scientific sources

General information only: this content cannot provide a diagnosis or prescription. A healthcare professional must assess your situation.