Shoulder Impingement

• Patients most often describe pain on raising their arm and sometimes a grinding sensation.
• Pain can be quite significant particularly at night, preventing sleep for many people.
• A rotator cuff tear may be suspected if a patient has difficulty or is unable to raise the arm.

Rotator cuff tendons usually glide smoothly between the acromion (upper edge of the shoulder blade) and the upper end of the humerus. When this action is compromised either due to degenerative changes, injury or overuse, the tendons become inflamed causing shoulder pain.

Tendonitis is common in people who have jobs where repetitive overhead work is required, such as painting or plastering. Similarly, tennis players and swimmers are also at risk of developing tendonitis due to the continuous demand put on the shoulder joint.

Overuse can also irritate the bursa found between the rotator cuff and acromion. These fluid filled sacs usually provide a cushioning effect between the bones and tendons but can easily become inflamed in a shoulder that is being overworked.

Rotator cuff tears can result from overuse, direct injury such as a fall or age related changes where a bony spur grows from the acromion or AC joint and rubs directly on the rotator cuff tendon. A tear may be partial, involving only a few of the tendon fibres, through to a full thickness tear. A full thickness tear can progress to a complete rupture where the tendon tears away from the bone.

A provisional diagnosis can often be made after a thorough physical examination. X-rays can be ordered and an MRI scan or ultrasound arranged if a rotator cuff tear is suspected. An arthrogram, where dye is injected into the shoulder joint and a series of x-rays are performed, can occasionally be needed to assist with diagnosis.

In the acute stage, treatment will initially be aimed at reducing pain and inflammation. This is often achieved by resting the shoulder joint in combination with non-steroidal anti-inflammatory medication. Icing the joint 3-4 times per day has also proven to assist with pain and swelling.

An exercise and strengthening program aimed at promoting shoulder mobility and rotator cuff strength may be arranged through a physiotherapist.

Cortisone injections can be considered if conservative methods do not achieve the desired results.

Surgery is usually discussed when other treatment methods have not been successful in reducing symptoms over time.

The aim of the surgery is to open up the area between the acromion and rotator cuff to prevent further tendon irritation. The undersurface of the bone is smoothed and any obvious bone spurs are removed. Removal of the sub-acromial bursa is occasionally performed at the same time.

This surgery can be performed via arthroscopy or a small open incision in the shoulder.

Rotator cuff repairs are also performed via arthroscopy or open incision depending on the size of the tear and the Doctors preference. Most often tears are situated where the tendon goes into the humerus bone. Surgical repair aims to reattach the rotator cuff back to the humerus using a suture or an anchor of plastic or metal.

Recovery usually requires a graduated exercise program to help regain strength and mobility in the shoulder.