مقدمة 

Repetitive movement at the shoulder joint is common among certain occupational activities and sports. These movements, as well as direct trauma to the joint, are associated with an increased incidence of rotator cuff tendonitis. Not only does it elicit shoulder pain, but rotator cuff tendonitis also affects physical activity and work productivity. While over-the-counter medications and other treatment options provide temporary pain relief, correct treatment procedures involve the resolution of the inflammation and proliferation stages of the healing cycle.  

Rotator Cuff Anatomy

The rotator cuff refers to a set of muscles at the shoulder or glenohumeral joint that stabilize movements at the joint. The shoulder joint allows a wide variety of movements, however, stabilization is compromised at the cost of the range of motion. Concerning the shoulder joint, the head of the humerus fits into the glenoid cavity of the scapula, the shoulder blade. The rotator cuff comprises subscapularis, infraspinatus, supraspinatus, and teres minor muscles. Tendons of these muscles form a musculotendinous collar along with the capsule of the shoulder joint. The musculotendinous collar surrounds the shoulder joint, except for its inferior aspect. [1]

ما هو Rotator Cuff Tendonitis?

Rotator cuff tendonitis is characterized by inflammation of tendons of rotator cuff muscles. Acute rotator cuff tendonitis occurs following direct trauma to the shoulder joint. Sport-related injuries are a common cause of rotator cuff tendonitis. Chronic rotator cuff tendonitis is associated with overuse and repetitive movements at the shoulder joint. Rotator cuff pathologies and shoulder pain occur in approximately 67% of individuals in their lifetime. Prevalence increases in individuals younger than 20 years and older than 80 years of age. People who suffer from rotator cuff tendonitis experience shoulder pain during movement and tenderness at the involved joint. [2] 

Symptoms of Rotator Cuff Tendonitis 

Patients who suffer from rotator cuff tendonitis present with the following signs and symptoms. [3]

1. The onset of pain and exacerbation of symptoms during movement of the arm above the level of shoulders. 
2. Stiffness of the shoulder and arm.
3. Weakness of muscles that are associated with the shoulder joint. 
4. The front of the shoulder joint is tender on the touch.
5. The person may feel pain when lying down on the involved shoulder joint. 
6. Limited range of motion at the affected shoulder joint. 

Causes and Risk Factors of Rotator Cuff Tendonitis

Rotator cuff tendinopathies arise due to an interplay between intrinsic and extrinsic environmental etiologic factors. Environmental factors responsible for eliciting rotator cuff tendonitis include degeneration of the rotator cuff structures and direct trauma of the shoulder joint. Mechanical compression accompanied with anatomic abnormalities also play a significant role in the pathogenesis of rotator cuff tendonitis. Intrinsic mechanisms are composed of vascular complications, age, and genetic predisposition of the affected individual. The inability of rotator cuff structures to withstand tensile forces is also an important cause of rotator cuff tendonitis. [2] 

Individuals who participate in contact sports, athletic activities that involve overhead movements, heavy lifting, and other occupational activities are more prone to developing rotator cuff tendonitis. 

دورة الشفاء الطبيعية 

Prior knowledge of the normal healing cycle is important for eliminating the underlying pathology of rotator cuff tendonitis. The healing cycle comprises the following stages. [4]

1. إشعال 

Inflammation is characterized by chemotaxis and vascular changes. During this stage, inflammatory mediators modulate increased vascular permeability that allows fluid and inflammatory cells to accumulate at the site of inflammation. This stage may last for several days and the primary goal is to eradicate the cause of inflammation. 

2. الانتشار 

The proliferation or the granulation stage involves the formation of new blood vessels, reepithelization, and the formation of granulation tissue. During this stage, fibroblasts deposit collagen fibers and extracellular matrix to serve as a scaffold for healing wounds.

3. إنضاج 

The maturation or recovery phase refers to the degradation of excess collagen fibers and the contraction of the wound. Failure of the healing cycle to proceed to the maturation phase and excess scar tissue formation may result in the onset of chronic inflammation. During chronic inflammation, the healing cycle alternates between the proliferation and inflammation stages, thus, persisting for longer periods.  

Rotator Cuff Tendonitis Treatments That Do Not Work

Various therapeutic techniques may be famous among the patients. However, these treatment options only provide temporary pain relief and some may even aggravate the symptoms of rotator cuff tendonitis. These methods do not cater to the inflammation and proliferation stages of the healing cycle, thus, are not effective for treating rotator cuff tendonitis. 

1. Heat and ice therapy 
2. التحفيز الكهربائي
3. Massaging and foam roller, along with joint mobilization and stretching, may further elevate shoulder pain and tendon injury.
4. Muscle-strengthening exercises during the inflammation phase. 

Effective Treatment for Rotator Cuff Tendonitis 

Adequate treatments for rotator cuff tendonitis targets inflammation and proliferation stages simultaneously. These treatments also register scar tissue, fascial restrictions, and trigger points in the rotator cuff muscles. Excess scar increases the risk for re-injury as well as limits the range of motion. One shall follow the mentioned steps and remain compliant throughout the treatment to procure maximum benefits. 

1. One shall refrain from repetitive motions associated with shoulder pain. 
2. Resolution of the inflammation stage requires the following.
   1. Adequate rest proves to be beneficial in the case of acute rotator cuff tendonitis. 
   2. MagnaHeal works on the principles of magnetic therapy for inflammation. MagnaHeal has varying magnetic fields that significantly reduce the inflammatory response. [5]
   3. Diet plays a significant role in modulating inflammation. Plant-based and unrefined foods contain essential fatty acids and phytonutrients are essential for minimizing the inflammatory response. One shall abstain from pro-inflammatory foods that include alcohol, caffeine, red meat, refined sugars, and sugary drinks. [6]
   4. Underlying nutrient deficiencies are also a prime reason for the impaired healing cycle. Supplementing the nutrient deficiencies improve inflammation significantly. AskASTR is a program designed to evaluate vitamin and mineral deficiencies as well as assist in choosing the right supplements. 
3. Resolution of the proliferation stage requires the following. 
   1. Release of scar tissue – A3 and A5 tools are used for releasing superficial and deep scar tissue respectively. 
   2. Release of fascia restrictions – superficial and deep fascial layers may adhere together and limit movement at the joint. A1 tool releases superficial and aponeurotic fascia layers while the A5 tool is used for epimysium, perimysium, and endomysium fascia release. [7]
   3. A3 and A5 tools are also employed for releasing muscle trigger points. 

خاتمة 

One must have acquired sufficient knowledge about the underlying pathology and treatment of rotator cuff tendonitis by now. Consumption of an anti-inflammatory diet, sufficient rest, overcoming nutrient deficiencies, and magnetic therapy are effective measures for the resolution stage. On the contrary, A1, A3, and A5 tools are useful for releasing scar tissue, fascia restrictions, and muscle trigger points. Compliance with treatment plays a significant role in the recovery process. 

مراجع 

1. https://www.ncbi.nlm.nih.gov/books/NBK441844/ 
2. https://www.ncbi.nlm.nih.gov/books/NBK532270/ 
3. https://www.ncbi.nlm.nih.gov/books/NBK531506/
4. https://www.ncbi.nlm.nih.gov/books/NBK470443/  
5. https://pubmed.ncbi.nlm.nih.gov/23594452/ 
6. https://pubmed.ncbi.nlm.nih.gov/28350517/ 
7. https://pubmed.ncbi.nlm.nih.gov/30252294/