Wednesday, January 11, 2006

Prevention and Treatment of Rotator Cuff Tendonitis with Arm Lymphedema


Rotator cuff tendonitis is an increasing problem in our Western societies. Having improperly treated or untreated arm lymphedema can put you at more of a risk for this condition.

The swelling may cause:

1.) Added strain to the shoulder muscles, ligaments and tendons due to the weight and volume of fluid.

2.) Cause nerve and vascular compression from not only the swelling, but from tissue changes that occur in fibrosis (hardening).

3.) Result in infections and added inflammation of the shoulder.

It is thus very important that we understand how to prevent rotator cuff tendonitis from happening and/or learn to recognize it early before an actual cuff tear occurs necessitating surgery.


The best preventative steps will be in preventing lymphedema from starting or in diligent management if you already have it.

For the arm at risk of lymphedema:

Become familiar with and practice the 18 steps of preventing arm lymphedema and also the early signs of arm lymphedema. If you experience any of the syptoms in that article, let your doctor know immediately and as for a referral to a certified lymphedema therapis. Do what you need to do to try and prevent lymphedema from starting.

If you already have lymphedema:


1.) It is imperative that you be compliant with your prescribed treatment program Work with and in cooperation with you therapist to get that swelling down and keep it down.

2.) Be diligent and consistent with your home care and daily management which will include correct exercise, skin care, bandaging, and self massage.

Both groups should read the below articles and learn to recognize the early warning symptoms of tendonitis.

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What is rotator cuff tendonitis?

Rotator cuff tendonitis, also knows as "bursitis" or "impingement syndrome" occurs when the rotator cuff gets irritated on the undersurface of the acromion. The reason this begins in the first place is a source of some debate: Some people are born with a "hooked" acromion that will predispose them to this problem. Others have rotator cuff weakness that causes the humerus to ride up and pinch the cuff. This means that the bursa - a water-balloon type structure that acts as a cushion between the rotator cuff and acromion/humerus - gets inflamed.

What are the symptoms of impingement syndrome?

Common symptoms of rotator cuff tendonitis include:

Pain - primarily on top and in the front of your shoulder.
Sometimes you can have pain at the side of your shoulder. Usually is worse with any overhead activity (reaching up above the level of your shoulder).
Weakness - mild to moderate weakness, especially worse with overhead activity.
Popping - sometimes bursitis that occurs with rotator cuff tendonitis can cause a mild popping or crackling sensation in the shoulder
Unable to sleep on shoulder - most patients complain of difficulty sleeping on the shoulder at night

How is impingement syndrome diagnosed?

Often, the diagnosis is suggested by your symptoms. Your orthopaedic surgeon or primary care physician can have you perform various maneuvers to detect this problem. This physical examination is designed to test your motion, strength, and certain positions of pain. In addition, plain x-rays can show a spur on the undersurface of the acromion. An MRI is occasionally ordered if a rotator cuff tear is suspected.

How do we treat rotator cuff tendonitis?

Just about all orthopedic surgeons agree that this problem should be treated initially "conservatively" - that means without surgery.

What are the steps to healing?

Stop any activities that can aggravate your symptoms. For example, if you're painting the ceiling in your garage and it's making your shoulder feel worse, stop doing it!

Do not ignore your body - it is telling you (with pain) that something is wrong.

Take medications, if necessary, to make you comfortable and decrease your pain.

Consider using
cryotherapy (cold therapy) to get your pain under control.

STRENGTHEN your rotator cuff!

Why does strengthening the rotator cuff muscles work?

When you have this tendonitis you get into a "vicious cycle":

First your rotator cuff is irritated for various reasons (overuse, injury, etc).

Then it doesn't work as well - and that causes increased pressure under the acromion bone.

The only way the acromion can react to that is to make new bone (a bone spur!).

That bone spur then presses on the rotator cuff.

So the rotator cuff gets MORE irritated, and then more weak, and so on... (go back to step 1)

earlier in this article, many people have rotator cuff tears, but no symptoms of shoulder pain.

What is the initial treatment for a rotator cuff tear?

Because many rotator cuff tears do not need surgery, the initial treatment is usually with conservative measures. While the size of the tear may not change with conservative treatment, the symptoms often diminish. In some cases, usually a traumatic rotator cuff tear in a younger patient, early surgery will be recommended.

However, the standard treatment is to start with conservative measures.

The first steps of rotator cuff treatment include:

Physical Therapy

Physical therapy is the most important step in the treatment of a rotator cuff injury. Strengthening the rotator cuff muscles is important to maintain normal shoulder function. A few meetings with a physical therapist can help teach you exercises to help alleviate and prevent a recurrence of your shoulder pain.

Anti-Inflammatory Medications

Medications are most helpful at controlling the symptoms of a rotator cuff tear. Simple anti-inflammatory medications can be taken regularly for a short period, and then be used when symptoms of a rotator cuff tear flare up.

Cortisone Injections

Cortisone injections can be incredibly helpful at limiting the acute inflammatory process and allowing the patient to begin therapy. It is important to participate in the therapy and exercises even if the shoulder feels better after an injection. The therapy part of treatment will help prevent a recurrence of symptoms.

These steps may help to relieve pain and strengthen the muscles around the joint

What treatments are available if I still have symptoms?

These conservative measures may not be effective in all patients. In general, a good effort at conservative therapy is first attempted, especially in older patients or in patients who have chronic (long-standing) injuries. In younger patients who have an acute, traumatic injury, sometimes surgery is considered early as the likelihood that conservative treatment will help is low. Surgery is also considered in patients who have tried conservative treatment, and still have difficulty with their shoulder.

Rehab and Exercises

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Information on the Shoulder:

Ortho Associates

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Next - The Surgery

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