Rotator cuff inflammation: definition, causes, symptoms, diagnosis and treatment

By Cristiano Antonino On May 12, 2023

Inflammation of the rotator cuff: the shoulder is a very complicated area of the human body that, with its set of five joints, driven by numerous muscle groups, forms the most mobile ‘joint’ in our body

The rotator cuff is a muscle complex that contributes to the movement of the shoulder joint and is responsible for keeping the joint between the scapula and humerus stable.

Inflammation of this set of muscles can bring a lot of discomfort to sufferers

Find out in this article what rotator cuff inflammation involves, possible causes, symptoms and other useful information such as possible treatments and prevention methods.

What is rotator cuff and why is it inflamed?

In anatomy, the term ‘rotator cuff’ is used to refer to the complex of muscles and tendons in the shoulder that forms a very important means of fixation and acts as a stabiliser of the scapulohumeral joint.

This name is due to the fact that the large tendons protect the entire shoulder joint by forming a true cuff that wraps around the head of the humerus.

The rotator cuff consists of 4 muscles which are

The supraspinatus muscle; its tendon passes under the coracoacromial ligament and inserts on the upper part of the humeral tuberosity.
The subspinatus muscle; its tendon inserts slightly below the insertion of the subspinatus muscle.
The small round muscle, located in the posterior part; its tendon inserts below the insertion of the subspinatus muscle.
The subscapularis muscle, in the anterior part; whose tendon is inserted on the tuberosity of the humerus.

The first three are extrarotator muscles while the last is an intrarotator muscle.

The relative tendons of these muscles are named after themselves.

Generally, most prone to injury and inflammation among the four are the tendons of the supraspinatus and subspinatus muscles.

As an area that is constantly subjected to stress, inflammation of the rotator cuff tendons is a very common condition, characterised by pain that often leads to restricted movement.

Furthermore, this structure, although complex, is particularly delicate and prone to degenerative phenomena that should be avoided through correct and healthy physical activity.

Given the countless stresses that the rotator cuff undergoes every day, there are many causes that can lead to inflammation and are often difficult to detect without a thorough investigation by a specialist.

Let’s look at some of them together.

The main causes responsible for rotator cuff inflammation include

Possible trauma caused by a very strong blow or fall.
Excessive repetition of movements that stress the joint between the scapula and the humerus, sometimes causing microtraumas in the same (a very frequent condition in people who practice sports).
Natural degeneration of tendon structures caused by old age or enforced immobility.
Muscle atrophy.
An inappropriate posture or an unnatural movement of the joint.

The even more probable hypothesis is that the inflammation of the rotator cuff is caused by a combination of two or more causes listed above.

Symptoms of rotator cuff inflammation

Patients who develop rotator cuff inflammation are subject to some specific symptoms such as:

Shoulder pain, often difficult to locate, not only during movements but very frequently also at rest, especially at night.
Shoulder muscle weakness.
Reduced range of motion.

Possible risk factors for inflammation

As already mentioned above, it is often those who practice intense sports who experience inflammation of the rotator cuff.

Among the sports most at risk are those that induce continuous stress on the joint between the scapula and the humerus such as tennis, swimming, rowing, weight lifting, basketball, rugby and, in general, all throwing sports.

Even elderly subjects are more at risk of accusing inflammation of the rotator cuff as, over the years, the blood flow to the joint decreases causing a decrease in fibrous proteins, in particular collagen, which are attached to both tendons and muscles.

Furthermore, people suffering from metabolic pathologies such as diabetes or obesity or from pathologies affecting the cardiovascular system are also at risk.

However, inflammation can also be caused by a job that leads to continuous stress on the joint or simply by a personal predisposition, due to the natural conformation of the shoulder or muscle weakness.

Methods to prevent inflammation of the rotator cuff

Of course, it is completely impossible to be sure that you will never suffer from rotator cuff inflammation, but there are many useful methods to decrease the chances of the inflammation appearing.

Here are some useful tricks to keep the most mobile joint of our body healthy:

Practice specific shoulder exercises to maintain good flexibility and strengthen the muscles.

Take care to do warm-up exercises before carrying out physical activity that involves the repeated use of the joint.

Immediately stop the activity that includes the use of the joint in case of pain or burning sensation in the shoulder.

Pay attention to efforts that include the use of the joint between the shoulder and the humerus.

Rest the joint if it hurts.

Furthermore, it is always useful to be checked by a specialist if the pain does not seem to disappear or you notice that the reduced mobility does not seem to improve.

How is the diagnosis made?

An in-depth clinical analysis, performed during a specialist visit, is usually sufficient to diagnose inflammation of the rotator cuff as the pain in performing some specific movements is enough to confirm the condition.

Usually, the patient is subjected to a simple mobility test: subjects affected by inflammation struggle to keep their arm raised laterally between 60° and 120°.

However, other in-depth tests may be requested by the doctor to rule out the possibility that the pain could be caused by other conditions such as a laceration or a fracture.

For this purpose, instrumental tests such as ultrasound of the shoulder or magnetic resonance imaging are used.

Sometimes then it can be useful to perform an X-ray, to highlight any bone imperfections that may be the cause of a slow but progressive consumption of the tendon, or to discover any calcifications of the tendon due to degeneration.

Only once the causes of the inflammation are understood can the doctor make a correct diagnosis and prescribe the most suitable therapy for the patient.

Possible treatments

In the event that the inflammation of the rotator cuff is mild, it will simply be sufficient to observe a period of rest and resort to taking non-steroidal anti-inflammatory drugs (NSAIDs).

Furthermore, the use of physical therapies or physiotherapy courses is strongly recommended, which involve the performance of exercises to stretch and strengthen the muscles, which are useful for increasing their quality and tone.

If the specialist deems it useful, he can prescribe a treatment based on corticosteroid infiltrations to the patient, in order to relieve the inflammation more quickly.

The patient can also be prescribed treatments useful to stimulate the natural regeneration of the tissues such as infiltrations of hyaluronic acid, platelet gel or Lipogerms.

Among the treatments prescribed in the most serious cases is focal shock wave therapy (Extracorporeal Shock Wave Therapy) which is based on mechanical stimulation of the shoulder tissues with the aim of inducing an anti-inflammatory and regenerative effect.

This procedure is indicated whether there is the presence of calcifications or in their absence.

Other useful treatments to treat rotator cuff inflammation are

Tecartherapy: a method that uses an electric capacitor to treat joint muscle injuries and tendinopathies. Its mechanism is based on the restoration of the electric charge in the cells subject to injury, so that they regenerate more quickly.
Laser therapy: which uses electromagnetic rays to act on the cell membrane and mitochondria, increasing their metabolic activity and reducing pain and inflammation.
Ultrasound: treatment that uses high-frequency acoustic waves, very useful as an anti-inflammatory.

Surgical treatment

Only in very rare cases is it necessary to resort to reconstructive surgery.

Surgical procedure is usually used in cases where there are lesions associated with inflammation, i.e. significant damage to the tendons or other connective structures that help form the joint.

In cases where this is possible, the arthroscopic technique is used, which helps to minimize recovery times after surgery and to make the rehabilitation period less difficult.

Arthroscopy is a modern surgical technique that allows doctors to perform operations inside a joint (be it shoulder, hip, knee or ankle) without having to make an incision to the joint capsule, if not a few millimeters.

Obviously, even after surgery, rehabilitation through physiotherapy and daily physical exercise plays a crucial role in ensuring the best possible prognosis.

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