Question

A recent MRI showed that I have "infraspinatus tendonopathy". My internist says that I need surgery. I am unclear about what this means. Can you please clarify?

Answer

Based on your MRI, you seem to have a case of shoulder tendonitis. Tendonitis (or tendonopathy) is inflammation (redness, soreness, and swelling) of a tendon. In tendonitis of the shoulder, the rotator cuff and/or biceps tendon become inflamed, usually as a result of being pinched by surrounding structures. The injury may vary from mild inflammation to involvement of most of the rotator cuff. When the rotator cuff tendon becomes inflamed and thickened, it may get trapped under the acromion (the top of your shoulder). Squeezing the rotator cuff is called the impingement syndrome. Repeated motions involving the arms, or the aging process involving shoulder motion over many years, may also irritate and wear down the tendons, muscles, and surrounding structures.

Tendonitis is often accompanied by inflammation of the bursa sacs (loose membranes containing a little fluid) that protect the shoulder. An inflamed bursa is called bursitis. Inflammation caused by a disease such as rheumatoid arthritis may cause rotator cuff tendonitis and bursitis. Sports involving overuse of the shoulder and occupations requiring frequent overhead reaching are other potential causes of irritation to the rotator cuff or bursa and may lead to inflammation and impingement. Signs of these conditions include the slow onset of discomfort and pain in the upper shoulder or upper third of the arm and/or difficulty sleeping on the shoulder. Tendonitis and bursitis also cause pain when the arm is lifted away from the body or overhead. If tendonitis involves the biceps tendon (the tendon located in front of the shoulder that helps bend the elbow and turn the forearm), pain will occur in the front or side of the shoulder and may travel down to the elbow and forearm. Pain may also occur when the arm is forcefully pushed upward overhead.

Your first step when an injury occurs is to see your doctor. I would expect that your own doctor would direct you to see a specialist, an orthopedic surgeon. This type of doctor can determine what treatments are required to help you. In general, there are a number of treatment options for patients with tendonitis. These range from the use of anti-inflammatory medicines to surgery. Other potential treatments can include physical therapy, ice packs, and even injection of corticosteroids into the space under the acromion. You should know that while steroid injections are a common treatment, they must be used with caution because they may lead to tendon rupture. Please see an orthopedic surgeon regarding your problem.

Links

• Rotator Cuff Exercises