Section 5. Bone, Joint, and Muscle Disorders

Chapter 75. Sports Injuries

Topics: Introduction | Stress Fractures of the Foot | Shin Splints | Popliteus Tendinitis | Achilles Tendinitis | Runner's Knee | Hamstring Injury | Lateral Epicondylitis | Medial Epicondylitis | Rotator Cuff Tendinitis

Rotator Cuff Tendinitis

Rotator cuff tendinitis (swimmer's shoulder, tennis shoulder, pitcher's shoulder, shoulder impingement syndrome) is a tearing and swelling of the rotator cuff (the muscles and tendons that hold the upper arm in the shoulder joint).

Rotator cuff tendinitis often occurs in sports that require the arm to be moved over the head repeatedly, such as pitching in baseball, lifting heavy weights over the shoulder, serving the ball in racket sports, and swimming freestyle, butterfly, or backstroke. Repeatedly moving the arm over the head causes the top of the arm bone to rub against part of the shoulder joint and its tendons, tearing individual fibers. If the movement is continued despite the pain, the tendon can tear or actually pull off part of the bone.

Shoulder pain is the main symptom. Initially, the pain occurs only during activities that require lifting the arm over the head and forcibly bringing it forward. Later, pain can occur even when the arm is moved forward to shake hands. Usually, pushing objects away is painful, but pulling them in toward the body is not. The involved shoulder may be particularly painful at night, disrupting the person's sleep.

The diagnosis is made when specific movements, especially raising the arm above the shoulder, cause pain and soreness. Magnetic resonance imaging (MRI) is the best diagnostic tool for this condition.

Treatment consists of resting the injured tendons and strengthening the shoulder. Exercises that involve pushing something away or raising the elbows over the shoulder should be avoided. Another exercise consists of the person using an elastic cord; the person places the arm at the side with the forearm parallel to the floor. The arm is then moved forward, backward, and rotated out away from the chest and then back in across the chest. This exercise program should restore balance to the rotator cuff and decrease impingement of the rotator cuff during activities that involve reaching overhead. Surgery is sometimes needed when the injury is particularly severe, the tendon is completely torn, or the injury does not heal within a year. Surgery removes excess bone from the shoulder to create a larger space for the rotator cuff. The rotator cuff is repaired at the same time.

See the sidebar Strengthening the Shoulders.