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Tendinitis of the rotator cuff is the major cause of a painful shoulder and is currently thought to be caused by inflammation of the tendons The rotaor cuff consists of the tendons of supraspinatus, infraspinatus, subscapularis, and teres minor muscles, and inserts on humeral tuberosities.Of the tendons forming rotator cuff, the supraspinatus tendon is most commonlyaffected probably because ofits repeated impingement(impingement syndrome) between the humeral head and the undersurface of the anterior third of the acromion and coracoacromial ligament above as well as reduction in its blood supply that occurs with abduction of arm. The tendon of infraspinatus and that of the long head of the biceps are less commonly incolved. The process begins with oedema and hemorrhage of the rotator cuff, which evolves into a fibrotic thickening and eventually to rotator cuff degeneration with tendon tears and bone spurs. Subacromial bursitis also accompanies this yndrome. Symptoms usually appear after injury or overuse, especiallywith activities involving elevation of arm with forward flexion. Impingement syndrome occurs in persons participating in baseball, tennis, swimming or occupations that require repeated elevation of arm with some degree of forward flexion. Impingement syndrome occurs in persons participating in baseball, tennis, swimming or occupations that require repeated elevation of the arm. Those over tha age 40 are particularly susceptible. Patients complain of dull aching in the shoulder, which may interfere with sleep. Severe pain is experienced when the arm is actively abducted into an overhead position. The arc between 60 and 120 is especially painful. tenderness is present over the lateral aspect of the humeral head just below the acromion. NSAIDs, local glucocorticoid injection and physical theraphy may relive symptoms. Surgical decompression of the subacromial space may be necessary in patients refractory to conservative treatment.
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