What is the management protocol for rotator cuff tendinitis?

Management Protocol for Rotator Cuff Tendinitis: Weekly Plan

The optimal management protocol for rotator cuff tendinitis involves a structured 12-week approach with physical therapy as the primary treatment, supplemented by appropriate medications and activity modifications. 1

Initial Phase (Weeks 0-4)

Pain Management

• NSAIDs (such as naproxen 500mg twice daily) to reduce inflammation and pain 1, 2
  • For elderly patients or those with renal/hepatic impairment, consider lower doses 2
  • Take with food to minimize GI side effects
• Acetaminophen (up to 3000mg/day) as an alternative or supplement to NSAIDs 1
• Ice application for 15-20 minutes several times daily, especially after activities

Activity Modification

• Avoid overhead activities and movements that provoke pain
• Maintain activities below shoulder level as tolerated
• Use proper ergonomics during daily activities

Physical Therapy (2-3 sessions per week)

• Gentle range of motion exercises 1
  • Pendulum exercises
  • Passive wall climbing
  • Rope and pulley exercises
• Postural correction exercises
• Patient education on proper shoulder mechanics

Intermediate Phase (Weeks 4-8)

Pain Management

• Continue NSAIDs as needed, using lowest effective dose 1, 2
• Consider a single corticosteroid injection if pain limits rehabilitation progress 1
  • Caution: Excessive corticosteroid use may impair tendon healing 1

Physical Therapy Progression

• Progressive strengthening exercises 1
  • Rotator cuff strengthening with resistance bands
  • Scapular stabilization exercises
  • Begin eccentric strengthening exercises
• Manual therapy techniques
• Functional movement patterns related to daily activities

Home Exercise Program

• Daily exercises (15-20 minutes, twice daily)
• Continued postural awareness training
• Self-mobilization techniques

Advanced Phase (Weeks 8-12)

Evaluation of Progress

• Assess response to conservative treatment 1
• If improvement is inadequate, consider:
  • PRP injection as an alternative intervention 1, 3
  • Ultrasound-guided needling and lavage for calcific tendinitis 4

Advanced Rehabilitation

• Sport or occupation-specific exercises
• Progressive resistance training
• Endurance training for rotator cuff muscles
• Functional movement patterns specific to patient's goals

Return to Activity Planning

• Gradual reintroduction of overhead activities
• Work-specific or sport-specific training
• Maintenance exercise program

Special Considerations

Calcific Tendinitis

• If calcific deposits are present, consider:
  • Ultrasound-guided needling and lavage (barbotage) for large deposits 4
  • Extracorporeal shock wave therapy as an alternative 4

Persistent Symptoms

• For patients with symptoms persisting beyond 12 weeks:
  • Re-evaluate diagnosis with advanced imaging (MRI or ultrasound) 1
  • Consider surgical consultation if significant functional limitation persists 1
  • Be aware that a sizeable proportion of patients may develop chronic tendinitis resistant to conservative treatment 5

Biceps Tendon Involvement

• If biceps tendinopathy is present alongside rotator cuff tendinitis:
  • Include specific biceps tendon exercises in rehabilitation
  • Consider biceps tenotomy or tenodesis if symptoms persist and surgical intervention is needed 6

Prognostic Factors

• Better prognosis: Early presentation, non-occupational overuse 5
• Poorer prognosis: Dominant arm involvement, older age, diabetes, and other comorbidities 1, 5

Common Pitfalls to Avoid

• Complete immobilization of the shoulder can lead to muscle atrophy and worsen outcomes 1
• Overuse of corticosteroid injections may impair tendon healing 1
• Inadequate pain management before bedtime can lead to sleep disruption and potential chronic pain development 1
• Progressing too quickly through rehabilitation phases can exacerbate symptoms

This structured 12-week protocol provides a comprehensive approach to managing rotator cuff tendinitis, with clear progression through rehabilitation phases while addressing pain management and functional recovery.