Assessment and management of rotator cuff tendinopathy.

Dr Jeremy Lewis PhD FCSP Consultant Physiotherapist | Professor of Musculoskeletal Research | Sonographer London Shoulder Clinic (www.LondonShoulderClinic.com), Centre for Health and Human Performance, London, UK. @JeremyLewisPT Central London Community Healthcare NHS Trust, London, UK. Title: Rotator cuff pathology: Pathology and Management Abstract: Musculoskeletal disorders of the shoulder are extremely common, with reports of prevalence ranging from 1 in 3 people experiencing shoulder pain at some stage of their lives to approximately half the population experiencing at least one episode of shoulder pain annually. Pathology of the soft tissues of the shoulder including the musculotendinous rotator cuff and subacromial bursa are a principal cause of pain and suffering. The pathoaetiology of rotator cuff failure is multifactorial and results from a combination of intrinsic, extrinsic and lifestyle factors. Rotator cuff tendinopathy is associated with changes within the subacromial bursa that are strongly related to the resulting symptoms. Competing theories have been proposed to explain the pathoaetiology of rotator cuff pathology at specific stages and presentations of the condition. Recently a new model detailing the continuum of rotator cuff tendon pathology has been proposed. This review describes the continuum of the rotator cuff pathology from asymptomatic tendon through full thickness rotator cuff tears. This model also provides a framework to stage the clinical continuity of rotator cuff disease and provides a framework for management. Current research evidence challenges the need to perform a subacromial decompression or rotator cuff repair for partial and non-traumatic full thickness tears of the rotator cuff. Evidence also exists that a specific exercise program may provide benefit for people suffering from symptomatic massive rotator cuff tears. References: Ainsworth R, Lewis J, Conboy V (2009) A prospective randomized placebo controlled clinical trial of a rehabilitation programme for patients with a diagnosis of massive rotator cuff tears of the shoulder. Shoulder & Elbow. 1(1):55-60. Lewis J (2015) Bloodletting for pneumonia, prolonged bed rest for low back pain, is subacromial decompression another clinical illusion? British Journal of Sports Medicine. 49 (5): 208-281. Lewis, JS (2011) Subacromial impingement syndrome: A musculoskeletal condition or a clinical illusion? Physical Therapy Reviews. 16(5): 388-398. Lewis J (2014) Management of rotator cuff tendinopathy. In Touch PhysioFirst Journal. 149. 12-17. Physiotherapy (4th edition). Jull G, Moore A, Falla D, Lewis JS, McCarthy C, Sterling M (eds) Elsevier, London. Cook JL, Rio E, Lewis JS. (2015) Managing tendinopathies. Grieve's Modern Musculoskeletal Physiotherapy (4th edition). Jull G, Moore A, Falla D, Lewis JS, McCarthy C, Sterling M (eds) Elsevier, London. Lewis JS, Ginn K. (2015) Rotator Cuff Tendinopathy & Subacromial Pain Syndrome. Grieve's Modern Musculoskeletal Physiotherapy (4th edition). Jull G, Moore A, Falla D, Lewis JS, McCarthy C, Sterling M (eds) Elsevier, London. Lewis J (2014) Shoulder Pain. MSK pain, basic mechanisms and implications. Graven-Nielsen T and Arendt-Nielsen L. IASP Press, Washington. McCreesh K, Adusumilli P, Evans T, Riley S, Davies A, Lewis J. (2014) Validation of ultrasound measurement of the subacromial space using a novel shoulder phantom model. Ultrasound in Medicine & Biology, 40(7):1729–1733. Ratcliffe E, Pickering S, McLean S, Lewis J (2013) Is there a relationship between subacromial impingement syndrome and scapular orientation? A systematic review. British Journal of Sports Medicine. Published Online First: 30 October 2013 doi:10.1136 McCreesh KM, Lewis JS (2014) Immediate response of the supraspinatus tendon to loading In rotator cuff tendinopathy British Journal of Sports Medicine.;48:Suppl 2 A42-A43 Podcast: http://physioedge.com.au/shoulderpodcast