Shoulder Impingement and Rotator Cuff Tendinitis
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.
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.
(Courtesy: www.aaos.org)
The space between the acromion and rotator cuff, which includes the bursa, becomes irritated and inflamed.
Frequently Asked Questions
Most shoulder pain can be treated with rest, anti-inflammatories and physical therapy. Any primary doctor or general orthopedist can prescribe these simple solutions, but a trained shoulder specialist won’t just treat your pain — they will diagnose and treat your specific problem.
At Modern Orthopaedics, our trained shoulder specialists will ask the right questions, perform specific examinations and order imaging when appropriate. They will be able to diagnose your problem and treat you whether your problem is simple or complex. Although you may not feel like your shoulder issue is “bad enough” to see a specialist, it is advantageous to have the opinion of an expert in the field when it comes to your health.
Before deciding on the treatment for your shoulder pain, our doctors will first diagnose your problem. Depending on the type and severity of your problem, the treatment options will vary.
Generally, physical therapy will be involved in the first step of treatment. You will work closely with a therapist two to three times a week to develop a routine that is tailored to your diagnosis and needs. Therapy may take some time to help, which is why a six-week trial is generally recommended before proceeding with other treatment options.
Cortisone injections are often used in orthopedics. Our doctors are conservative when it comes to using cortisone injections and reserve them for specific situations. They are most commonly used for patients who may have a stiff or frozen shoulder or shoulder arthritis. They use them less commonly for rotator cuff issues, but there are exceptions. Each patient’s situation is unique, and our doctors will work with you to ensure the highest level of care.
Surgical intervention is reserved for shoulder issues that do not respond to more conservative measures or acute injuries that need to be addressed right away. The most common shoulder surgeries performed by our doctors are done arthroscopically. This allows for smaller incisions and a quicker recovery for our patients. The length of recovery, immobilization period and rehabilitation protocol differ depending on the surgery.
Personalized care
As our patient, you will have an in-depth consultation with one of our doctors. We will create an individualized treatment plan together, tailored to your problem and lifestyle. Our doctors prefer non-invasive treatments whenever possible, including physical therapy and/or injections. If your problem ultimately does require surgery, our doctors prefer the least invasive surgical techniques possible. Our goals are the same as yours: to get you back to living your best life, pain free.
