What is the typical pain pattern associated with Rotator Cuff Tendonitis (RCT)?

Typical Pain Pattern in Rotator Cuff Tendonitis (RCT)

The typical pain pattern associated with Rotator Cuff Tendonitis (RCT) is characterized by insidious onset of load-related localized pain in the anterior or anterolateral aspect of the shoulder that worsens with overhead activities, with patients describing their pain as "sharp" or "stabbing." 1, 2

Primary Pain Characteristics

• Pain is typically located in the anterior or anterolateral aspect of the shoulder and worsens with overhead activities (sensitivity 88%, specificity 33% with Neer's test) 2
• Pain initially occurs during activity but may subside after a warm-up period, gradually increasing in intensity and duration as the condition progresses 1
• In advanced stages, pain may be present even at rest 1
• Night pain is a common feature, particularly in cases of chronic impingement tendonitis 3
• Pain is often sharp and stabbing in quality, especially during specific movements 1, 4
• Pain may radiate down the arm and be associated with dull, aching sensations that can extend to the hand 4

Pain During Specific Activities and Movements

• Pain is exacerbated by specific shoulder movements, particularly:
  • Abduction with external or internal rotation 2
  • Overhead activities 2
  • During specific phases of throwing motions in athletes (arm cocking and acceleration phases) 2
• Positive clinical tests that reproduce the characteristic pain include:
  • Hawkins' test (forcible internal rotation with the arm flexed forward at 90 degrees) - 92% sensitive but only 25% specific for impingement 2, 5
  • Neer's test - highly sensitive (88%) but less specific (33%) 2

Pain Progression and Associated Symptoms

• Pain typically follows a progressive pattern, starting with activity-related discomfort and potentially developing into constant pain 1
• Focal weakness in the affected shoulder is common (75% prevalence in one study) 2
• Decreased range of motion, particularly during abduction with external or internal rotation 2
• In throwing athletes, decreased velocity and precision may accompany the pain 2
• If left untreated, the condition may progress to tendon degeneration and possible rotator cuff tears 2, 3

Differentiating Features

• In primary impingement (more common in adults), pain results from compression of the rotator cuff against the anterolateral aspect of the acromion 2
• In secondary impingement (more common in younger individuals and athletes), pain is associated with difficulty for the humeral head to stay centered in the glenoid fossa during arm motion 2
• Pain from acromioclavicular joint pathology tends to be more localized to the anterosuperior shoulder area compared to the more diffuse pattern of RCT 4
• Pain from glenohumeral joint arthritis is typically more severe and affects the entire arm, unlike the more localized pattern of RCT 4

Common Pitfalls in Diagnosis

• RCT pain may be confused with other shoulder conditions like calcific tendonitis, which presents with more severe sharp pain limited to the upper arm and shoulder 4
• Lymphedema can complicate the presentation of rotator cuff tendonitis, requiring careful assessment of all potential contributing factors 6
• Multiple symptomatic tendons should prompt consideration of rheumatic disease 1
• Scapular dyskinesis (poor coordination of scapular movements during arm elevation) may contribute to the pain pattern and should be assessed 2

Understanding this characteristic pain pattern helps in early diagnosis and appropriate management of rotator cuff tendonitis, potentially preventing progression to more severe tendon degeneration and tears.