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Impingement Syndrome/Rotator Cuff Tendonitis

Shoulder impingement occurs when the space for the rotator cuff is too small. This can be due to bone spurs from the bone above, called the acromion, or swelling in the rotator cuff muscles when they are overworked or overused due to repetitive overhead motion. This swelling, also referred to as inflammation, in the rotator cuff tendon is often referred to as rotator cuff tendonitis. Tendonitis is a condition characterized by inflammation of a tendon (fibrous tissue that connects muscle to bone) that develops over a period of time. In this case, the muscles and tendons are inflamed but not torn

Impingement Syndrome/Rotator Cuff Tendonitis Hero Image 2

Shoulder impingement occurs when the space for the rotator cuff is too small. This can be due to bone spurs from the bone above, called the acromion, or swelling in the rotator cuff muscles when they are overworked or overused due to repetitive overhead motion. This swelling, also referred to as inflammation, in the rotator cuff tendon is often referred to as rotator cuff tendonitis. Tendonitis is a condition characterized by inflammation of a tendon (fibrous tissue that connects muscle to bone) that develops over a period of time. In this case, the muscles and tendons are inflamed but not torn.

What causes Impingement Syndrome/Rotator Cuff Tendonitis?

Impingement syndrome occurs from two causes:

• Age-related development of bone spurs on the bone above the rotator cuff, called the acromion
• Inflammation and swelling in the rotator cuff tendon due to overuse from consistent movements that keep the shoulder over the head, such as pitching a baseball

Weakness of the rotator cuff tendons allows the humerus bone to pull up closer to the acromion, worsening the impingement.

Rotator cuff impingement and rotator cuff tendonitis is common in these sports:

• Baseball
• Swimming
• Tennis
• Volleyball
• Golf

Symptoms

If you experience symptoms of shoulder impingement, they may be mild at first. You are most likely to experience:

• Pain on the outside of the shoulder
• Pain when performing overhead motions, like serving a tennis ball
• Pain that worsens when sleeping on the affected shoulder
• Stiffness in the affected shoulder

If left untreated, symptoms of shoulder impingement and rotator cuff tendonitis can worsen and can lead to:

• Loss of mobility in the affected shoulder
• Loss of strength in the affected arm
• Tearing, also referred to as a rupture, of the inflamed tendon

When to see a doctor

If you have pain that does not subside, pain that progressively gets worse, or experience loss of motion, make an appointment to visit an orthopedic specialist, you may have a more serious injury, like a tear of the rotator cuff. During your appointment, your doctor will examine your shoulder by testing its range of motion as well as the strength of the affected shoulder and the arm. In order to make a diagnosis, your doctor may prescribe imaging tests, such as:

X-rays
MRI
Ultrasound

Non-operative treatment

The goal of shoulder impingement/rotator cuff tendonitis treatment is to increase the space for the rotator cuff tendons. It is also important to reduce swelling in the area. One of the most important actions you can take in order to heal rotator cuff tendonitis is to avoid activities that cause inflammation. You may also try non-operative treatments to alleviate pain and inflammation associated with rotator cuff tendonitis, such as:

• Resting the affected shoulder and arm
• Applying ice to the affected shoulder
• Anti-inflammatory medication, such as ibuprofen, to reduce swelling
• Physical therapy to strengthen the muscles of the shoulder (more specifically the scapula muscles to increase the space for the rotator cuff under the acromion)
• Injections for pain relief and to reduce inflammation, such as corticosteroid injections (administered to you by an orthopedic specialist)

You can also try these exercises at home to stretch and strengthen the muscles surrounding the shoulder:

Impingement Syndrome/Rotator Cuff Tendonitis

Surgical Treatment

If non-surgical treatments do not relieve your symptoms, then surgery may be considered. The type of surgery used to treat shoulder impingement/rotator cuff tendonitis is called a subacromial decompression.

 

The goals of surgical treatment of shoulder impingement are to:

Increase the space for the rotator cuff by removing any bone spurs located on the acromion that may be impinging on the inflamed tendon
Remove tissue that is recurrently inflamed and/or thickened

Surgery for impingement is usually performed arthroscopically. Arthroscopy is a minimally invasive surgical technique which uses tiny incisions (roughly one centimeter long) through which special instruments and a camera attached to a thin, flexible tube are inserted into the shoulder. During a subacromial decompression surgery, the surgeon removes the bone spurs and treats any damaged tissue.

Recovery

Depending on the severity of tendonitis, recovery without surgery can take as little as two to four weeks, or up to two to four months. If you require surgery, recovery can range from six to 10 weeks.

Following surgery for rotator cuff tendonitis, your arm will be placed in a sling. This limits movement and allows the shoulder to heal. Once directed by your doctor, the sling will be removed and your doctor will start you on an exercise program to strengthen the muscles of the shoulder and help you regain range of motion.

You should not return to overhead sports until you are pain-free and have recovered with full range of motion and strength.

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