The guidelines established by the New York State Workers Compensation Board are designed to aid healthcare professionals in delivering suitable treatment for rotator cuff tendinitis.
Crafted for medical practitioners, these Workers Compensation Board guidelines offer assistance in determining the appropriate approach for individuals with rotator cuff tendinitis.
It’s crucial to note that these guidelines do not replace clinical judgment or professional experience. The final decision on treatment for rotator cuff tendinitis should be a collaborative one, involving the patient and their healthcare provider in consultation.
Inflammation of Musculotendinous Structures:
Definition:
- Inflammation of one or more of the four musculotendinous structures originating from the scapula and inserting on the lesser or greater tuberosity of the humerus.
- Structures include one internal rotator (subscapularis) and two external rotators (infraspinatus and teres minor), along with the supraspinatus, which aids in abduction.
History and Mechanism of Injury:
Mechanism of Injury:
- Established with sudden trauma to the shoulder or chronic overuse involving repetitive overhead motion with internal or external rotation.
Physical Findings:
Physical Findings may include:
- Pain with Palpation: During active or passive abduction and external rotation of the shoulder (painful arc).
- Pain with Impingement Signs; and/or
- Pain with Specific Activation: Of the involved muscles.
Laboratory Tests:
Indication:
- Generally not indicated.
- Recommended in select patients where a systemic illness or disease is suspected.
Testing Procedures:
Testing Procedures may include:
- X-Ray:
- Recommended in select patients as clinically indicated.
- Plain x-ray films, including AP lateral, axial, 30 degrees caudally angulated AP, outlet view.
- If shoulder pain persists despite four to six weeks of nonoperative care and the diagnosis is not identified by standard radiographic techniques.
- Adjunctive Testing (MRI, Sonography, Arthrography, or MRI):
- Recommended in select patients as clinically indicated to rule out a rotator cuff tear.
- Indications: Shoulder pain persists despite four to six weeks of nonoperative care, and the diagnosis is not identified by standard radiographic techniques.
- Subacromial Space Injection:
- Recommended in select patients as clinically indicated.
- Can serve as a diagnostic procedure by injecting an anesthetic (e.g., sensorcaine or xylocaine solutions) into the space.
- If pain is alleviated with the injection, the diagnosis is confirmed.
Non-Operative Treatment Procedures:
Medications:
- Medications, such as nonsteroidal anti-inflammatories, oral steroids, and analgesics, may be included in non-operative treatment procedures.
Subacromial Space Injection with Steroids:
- Recommended in select patients as clinically indicated.
- Indications: May be therapeutic if the patient responded positively to a diagnostic injection of an anesthetic.
- Steroid injections directly into the tendons are not advised.
- Frequency: Not more than two to three times annually, usually one or two injections adequate.
- Minimum three-week interval between injections recommended.
- Time to produce effect: Immediate with local anesthetic or within three days with corticosteroids.
- Maximum duration: Limited to three injections annually to the same site.
Non-Operative Treatment Procedures/Modalities:
- Relative rest, immobilization, thermal treatment, ultrasound, therapeutic exercise, physical medicine, and rehabilitation should be limited to the first two to three weeks during the acute phase of shoulder discomfort.
- Active therapies should be introduced as soon as appropriate.
Operative Procedures:
- Operative procedures are generally not indicated for this diagnosis in most patients.
- Indicated for tendinitis with small partial thickness tearing unresponsive to non-operative treatment for four to six months.
