Shoulder Impingement and Rotator Cuff Tear
What is Rotator Cuff Impingement
A rotator cuff impingement is a type of injury that causes shoulder pain. It affects the muscles and tendons between your arm bone and the top of your shoulder. You use this group of muscles and tendons, called the rotator cuff, to move and lift your arms.
An impingement happens when one of these tendons is injured, causing it to swell and get pinched by the bony top of your shoulder joint. The “pinching” makes it hard for blood to flow through. Because of that, your tendon can start to fray and split like a piece of rope.
Doctors sort these injuries into three grades based on your symptoms and how much damage the impingement causes:
- Grade 1: swelling and inflammation
- Grade 2: tendinopathy, or weakened tendons in the shoulder
- Grade 3: tears in the rotator cuff or changes in the shoulder bone, such as the growth of bony spurs called osteophytes
St. Theresa's Hospital best quality Rotator Cuff Impingement and shoulder Impingement Treatment in Hyderabad at most affordable cost
Dr. Divakar Reddy
MS ORTHO, JIPMER MRCS – EDINBURG
Symptoms of Rotator Cuff Tear
Rotator cuff pain commonly causes local swelling and tenderness in the front of the shoulder. You may have pain and stiffness when you lift your arm. There may also be pain when the arm is lowered from an elevated position.
Sudden tears from accidents cause immediate, intense shoulder pain and arm weakness. With degenerative tears, you may have mild pain that improves with over-the-counter pain relievers. Over time, the pain gets worse, and pain relievers don’t help. Not everyone has pain, but most people have some degree of arm and shoulder weakness.
Signs of a rotator cuff tear include:
- Difficulty and pain caused by raising your arm.
- Popping or clicking sounds or sensations when moving your arm.
- Shoulder pain that worsens at night or when resting your arm.
- Shoulder weakness and struggling to lift items.
Beginning symptoms may be mild. Patients frequently do not seek treatment at an early stage
Diagnosis of Shoulder Impingement
Your healthcare provider will take your medical history and perform a physical examination to check for pain and tenderness. Your provider will also assess the range of motion of your shoulder and your arm/shoulder strength. They will ask if you are involved in repetitive activities that require overhead arm movement, what remedies you have tried to relieve your pain, prior injuries to the affected arm/shoulder and any details about what may have caused your shoulder pain and when it began.
Other tests which may help your doctor confirm your diagnosis include:
X-rays – Because X-rays do not show the soft tissues of your shoulder like the rotator cuff, plain X-rays of a shoulder with rotator cuff pain are usually normal or may show a small bone spur. A special X-ray view, called an outlet view, sometimes will show a small bone spur on the front edge of the acromion.
Magnetic resonance imaging (MRI) and ultrasound – MRI scans can create better images of soft tissues, like the rotator cuff tendons, than X-rays. They can show fluid or inflammation in the bursa and rotator cuff. In some cases, partial tearing of the rotator cuff will be seen.
Impingement and rotator cuff tears can be treated non-operatively or with surgery.
Treatment for both injuries usually begins with a non-operative treatment plan. More than 2/3 of impingement patients can expect significant improvement in their symptoms with a physical therapy program alone. These results are lower in older patients and in those with large bone spurs.
When trauma causes a tear in younger patients, surgery is often the first choice of treatment. Patients with this type of injury recover best if surgery is done early. Generally, this pertains to those patients under the age of fifty with tears less than four weeks old.
Non-Operative Treatment is similar for both impingement and rotator cuff tears. A vast majority of patients improve with this primary treatment alone. The goals of a physical therapy program include:
- strengthening the rotator cuff tendons.
- stretching and regaining lost motion caused by pain and inflammation.
- allowing the humerus to be better positioned under the acromion, thus reducing compression of the bursa.
Anti-inflammatory medication may be prescribed to help reduce pain and inflammation. Many patients with rotator cuff tears can function quite well if pain and inflammation are controlled with medication and physical therapy. This is especially true for the elderly and those with low demands on the shoulder.
If symptoms have not improved with this program, the doctor may recommend a steroid injection into the bursa. Cortisone, or a similar steroid, is often combined with a local anesthetic to help control the pain and inflammation of the bursa. Steroid injections are used with caution. Damage to the rotator cuff tendons may occur with more than two or three injections over several months. Patients with diabetes are generally not good candidates for steroid injections because of problems with glucose control.