EMEDx Sports Medicine and Fitness Information

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(Impingement Syndrome)

 Definition Rotator cuff tendonitis and tears are common disorders of some of the muscles that control movement of the arm and shoulder. Rotator cuff tendonitis and tears are collectively known as Impingement Syndrome.

Diagram and Xray of a Normal Shoulder
Details The rotator cuff is a series of four muscles that function to stabilize your shoulder and allow your arm to move through a full range of motion. The muscle tendons are lubricated by a fluid filled sac called the subacromial bursa. Impingement occurs when inflammation or bony spurs narrow the space available for the rotator cuff tendons. The syndrome is divided into 3 stages:

Stage I: Swelling and Mild Pain
Stage II: Inflammation and Scarring
Stage III: Partial or Complete tears of the rotator cuff

X-ray and Arthroscopic Pictures of Shoulder Spurs
Causes Rotator Cuff tendonitis and tears occur from either a sudden violent movement of the shoulder or from chronic overuse. Sports commonly associated with this diagnosis include: Tennis, Swimming, Baseball, Softball and Football.
Diagnosis The diagnosis of Impingement Syndrome is considered when patients complain of pain with overhead arm activities such as a tennis serve or pitching. The physical exam will reveal weakness of the rotator cuff muscles and may also show a decreased range of motion of the shoulder. X-rays are taken to evaluate the bones of the shoulder. Occasionally, an MRI or shoulder arthroscopy is used to confirm the diagnosis.

MRI scans of normal and torn rotator cuffs
Treatment Nonoperative: Most cases of Impingment Syndrome will respond to rest, anti-inflammatory medication and a directed course of physical therapy. Resolution of symptoms typically takes several weeks. Return to full activity may, however, take several months depending on the severity of the problem. Occasionally, a steroid injection may also be used to help alleviate pain in older patients.

Operative: If non-operative measures fail to control the pain and restore full function, surgery may be needed. Surgery is done to either remove the scarred and inflammed tissue (bursitis) and or open up the space available for the rotator cuff by shaving down spurs (Subacromial Decompression). Repair or reattachment of torn rotator cuff tendons may also be necessary.

Two types of surgery are possible. Arthroscopic surgery involves the use of small instruments and small incisions. This type of surgery is best for patients with severe inflammation and partial rotator cuff tears.  Full thickness tears can also be repaired arthroscopically.

Arthroscopic Pictures of a Partial Rotator Cuff Tear

Arthroscopic Pictures of Subacromial Bursitis with removal animation

Picture of operating room during Shoulder Arthroscopy Surgery

Open surgery involves larger incisions and is more often required for patients with full thickness rotator cuff tears. Arthroscopic rotator cuff repair is now more common.  The results in experienced surgeon's hands are now similar if not better than open methods..  
Prevention Prevention of rotator cuff tears is best accomplished by maintaining a strong and stable shoulder. Avoiding repetitive overhead activity and improving the flexibility of the shoulder muscles may also help.