Overview of Rotator Cuff Impingement, Bursitis, and Tendinitis
Shoulder pain is one of the most common problems in patients or in athletes who deal with overhead movements of the shoulder. One of the most common reason for shoulder pain is a problem with the rotator cuff or the surrounding tissues. The rotator cuff is a group of four muscles that attach to the humeral head and the scapula and help move the shoulder in space. The rotator cuff and overlying bursa can sometimes become inflamed if the rotator cuff muscles hit the undersurface of the acromion.
Definition of Rotator Cuff Impingement, Bursitis, and Tendinitis
Impingement syndrome is pain and inflammation that occurs when the rotator cuff tendons rub against the roof of the shoulder, the acromion, when you lift the arm. Sometimes bone spurs on the undersurface of the acromion or clavicle can make people prone to this condition or keep the area inflamed.
The bursae above the rotator cuff is connective tissue that forms fluid to decrease the normal friction that is present when we move the shoulder joint. Bursitis is inflammation of the connective tissues above the rotator cuff and below the acromion. When bursal tissue is inflamed it can become thickened and painful. When very inflamed, the tissues can form thickened fibrous bands that can cause a popping sensation when moving the shoulder joint.
Tendinitis can occur when there is abnormal stress on a tendon leading to inflammation. It can occur due to many causes including trauma and overuse. The rotator cuff tendons can become inflamed after repeatedly hitting the undersurface of the acromion.
Symptoms of Rotator Cuff Impingement, Bursitis, and Tendinitis
In the early stages impingement syndrome causes a generalized shoulder and pain when raising the arm out to the side or in front of the body. Most patients complain that the pain makes it difficult for them to sleep, especially when they roll onto the affected shoulder. As the condition worsens, the discomfort increases. Sometimes a catching sensation is felt when you lower your arm. Weakness and inability to raise the arm may indicate that the rotator cuff tendons are actually torn. A proper history and physical exam by a doctor proficient in shoulder disorders can help to differentiate the different conditions that often cause pain in the shoulder whose symptoms can overlap.
Treatment of Rotator Cuff Impingement, Bursitis, and Tendinitis
Many cases of impingement can be treated successfully without needing surgery. You may be prescribed anti-inflammatory medications such as meloxicam or ibuprofen. Resting the sore joint and putting ice on it can also ease pain and inflammation. If the pain doesn’t go away, an injection into the joint may help. Injections contain strong medications that can decrease inflammation and reduce pain. Your doctor may also refer you for physical therapy depending on your condition. Your therapist will use various treatments to calm inflammation, including heat and ice. Therapists use hands-on treatments and stretching to help restore full shoulder range of motion. Improving strength and coordination in the rotator cuff and shoulder blade muscles lets the humerus move in the socket without pinching the tendons or bursa under the acromion.
If you are still having problems after trying nonsurgical treatments, your doctor may recommend surgery. Subacromial decompression and bursectomy is a procedure that increases the space between the acromion and the rotator cuff tendons, relieving the pressure off the tissues under the acromion. The surgeon must first remove any bone spurs under the acromion that are rubbing on the rotator cuff tendons and the bursa. Usually the surgeon also removes a small part of the acromion to give the tendons even more space. Surgically cutting and shaping the acromion is called acromioplasty. Today, it is more common to do this procedure using the arthroscope. An arthroscope is a slender tool with a tiny TV camera on the end. It lets the surgeon work in the joint through a very small incision. This may result in less damage to the normal tissues surrounding the joint, leading to faster healing and recovery.
Surgery for rotator cuff impingement, bursitis, and tendinitis is not to be undertaken lightly; however, if performed for the right reasons it can result in significant pain relief and an increased quality of life. If you have any further questions please don’t hesitate to schedule an appointment with Dr. Mazoch.