Rotator cuff

Shoulder Tendinopathies

All shoulder tendon disorders: supraspinatus, infraspinatus, subscapularis. Global rehabilitation approach.

Shoulder tendinopathies encompass all degenerative and inflammatory disorders of the periarticular tendons: supraspinatus (most common), infraspinatus, subscapularis, and long head of biceps. The Cook & Purdam tendon continuum model distinguishes 3 phases: reactive tendinopathy (acute overload), tendon disrepair (chronicity), degenerative tendinopathy (irreversible structural changes). The therapeutic approach is guided by stage: load management in the reactive phase, eccentric and isometric exercises in the disrepair phase, functional adaptation in the degenerative phase.

Characteristics

  • Shoulder pain worsened by specific movements depending on the affected tendon: elevation (supraspinatus), external rotation (infraspinatus), internal rotation (subscapularis), resisted flexion (biceps).
  • Specific clinical tests: Jobe (supraspinatus), Patte (infraspinatus), lift-off and belly-press (subscapularis), Speed and Yergason (long head of biceps). Combining tests improves diagnostic accuracy.
  • Dynamic ultrasound: real-time evaluation of rotator cuff tendons during movement. Detection of partial tears, calcifications, subacromial bursitis.

Medical and surgical management

  • Conservative treatment first line: specialized physiotherapy 3-6 months, topical or oral NSAIDs, subacromial corticosteroid injection if associated bursitis.
  • PRP (Platelet-Rich Plasma): ultrasound-guided injection into the degenerate tendon. Promising results for chronic tendinopathies resistant to conventional treatment.
  • Partial tear > 50% thickness or symptomatic complete tear: arthroscopic repair. Arthroscopic debridement for partial tears < 50% resistant to treatment.

Physiotherapy rehabilitation

  • Reactive phase: load management (reduction of provocative activities, not complete rest). Analgesic isometric exercises (45 seconds, 3-5 sets).
  • Disrepair phase: progressive eccentric exercises (Alfredson protocol adapted to the shoulder). Progressive loading to stimulate tendon repair.
  • Correction of contributing factors: scapular dyskinesis, posterior capsular tightness (sleeper stretch), glenohumeral internal rotation deficit (GIRD).

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.