Shoulder Impingement/Rotator Cuff Tendinitis
Shoulder anatomy
Shoulder. A ball-and-socket joint made up of three bones:
- The humerus (upper arm bone)
- The scapula (shoulder blade)
- The clavicle (collarbone)
Muscles and tendons. Form a covering around the head of the humerus and attach it to the shoulder blade, allowing the range of motion in your arm.
Rotator cuff. Keeps your arm in the shoulder socket
Bursa. Lubricating sac between the rotator cuff and the bone on top of your shoulder (acromion) that allows the rotator cuff tendons to glide freely when you move your arm.
Symptoms of pain in rotator cuff
- Local swelling and tenderness in the front of the shoulder.
- Pain and stiffness when you lift your arm, also the arm is lowered from being elevated.
- Minor pain present both with activity and at rest
- Pain radiating from the front of the shoulder to the side of the arm
- Sudden pain with lifting and reaching movements. Athletes may have pain when throwing or serving a tennis ball
- Pain at night
- Loss of strength and motion, which may be limited and painful (sometimes feels like a shockwave through the arm)
- Difficulty doing activities that place the arm behind the back, such as buttoning or zipping clothing
Causes of rotator cuff pain
- Experienced by athletes who use their arms overhead for swimming, baseball, and tennis.
- People who do repetitive lifting or overhead activities. E.g. wallpaper hangers, painters
- Minor injuries
- Pinched nerve and arthritis may also be the root cause and need to be ruled out
Result in one or all of the following:
- Tendinitis. Damage or irritation to rotator cuff tendons.
- Bursitis. The bursa can become inflamed and swell with more fluid causing pain.
- Impingement. When you raise your arm to shoulder height, the space between the acromion and rotator cuff narrows. The acromion can rub against (or impinge on) the tendon and the bursa, causing irritation and pain.
Treatment for shoulder pain / rotator cuff pain
Avoid overhead activities
Physical therapy. Particularly stretching exercises to improve range of motion;
Anti-inflammatory tactics
- Non-steroidal anti-inflammatory drugs (NSAIDs). E.g. ibuprofen, aspirin, and naproxen reduce pain and swelling. Especially helpful at night to help numb the pain so you can get some sleep. Don’t overdo painkillers, which can lead to other problems
- Pulsed electromagnetic field (PEMF) therapy in area of rotator cuff
Imaging tests
Xrays. May reveal a small bone-spur but do not show good images of soft tissue
MRIs. Image soft tissues, including the rotator cuff tendons, showing fluid or inflammation in the bursa and rotator cuff, and possibly partial tearing of the rotator cuff
