Shoulder Impingement and Rotator Cuff Tendinitis

Your shoulder in a complex joint with many muscles, tendons, ligaments and bones contributing to the wide range of motion that your arm is able to perform. The bursa (a lubricating sac) is located between the rotator cuff tendons and the acromion (the bone located at the top of the shoulder). The space between the acromion and rotator cuff narrows when the arm is raised above the shoulder. The acromion can rub against (or “impinge” on) the tendon and the bursa, causing irritation and pain. Shoulder impingement occurs when the bursa is irritated, causing pain. This is not to be confused with rotator cuff tendonitis which is the irritation and inflammation of the rotator cuff tendons. Both of these conditions can occur individually or simultaneously and are often caused by the same mechanisms of injury which include repetitive overhead motion, overhead activities (i.e. baseball, swimming — See “Throwing Shoulder” for more information), acute injury to the shoulder and can sometimes occurs without any apparent cause. Symptoms include pain located to the front of the shoulder that occurs with shoulder motion (especially overhead motion), but it can progress to pain at rest, pain radiating from the front of the shoulder to the side of the arm, pain at night and loss of strength and motion. Diagnosis of these conditions can usually be made with a thorough physical exam in the office, and treatment is almost always conservative. Initial treatment begins with rest of the shoulder, NSAIDs and then physical therapy. Sometimes a steroid injection may be offered if initial treatment is not effective.