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The rotator cuff refers to the four muscles and their respective tendons that surround the shoulder joint. Individually, the tendons are: supraspinatus, infraspinatus, subscapularis, and teres minor. These muscles and tendons help with vertical and rotational movement of the arm

 

Overview

Impingement syndrome is a condition in which the supraspinatus tendon of the rotator cuff rubs against the acromion, the bone directly above the tendon. Impingement is a common cause of tendinitis (inflammation of a tendon). When the supraspinatus tendon rubs against the acromion it becomes irritated and inflamed. Once inflamed, the tendon rubs even more on the acromion, exacerbating the condition. This causes pain in the shoulder that can present itself in different places in different people. Some experience pain at the back of the shoulder, while others experience pain in the front or on the top of the shoulder. Depending on the severity of the tendinitis, the pain may be constant or only experienced during particular movements.

 

Causes

Impingement and tendinitis may be caused by either an acute injury or by chronic injury. Accidents such as falling on an outstretched arm or lifting a heavy weight overhead may injure and inflame the tendon. Chronic injuries may result from repetitive overhead work or repetitive upper extremity use at a computer desk.

 

Diagnosis

Impingement and tendinitis can be diagnosed using physical exam tests that involve range of motion and strength testing. Pain that is experienced in the shoulder during these tests is indicative of supraspinatus tendinopathy. A health professional may also consult a MRI scan of the shoulder to verify findings of a physical examination and/or symptoms as described by the patient.

 

Treatment Options

Treatment options for individual patients are often dependent on the severity of the symptoms. Often, impingement and rotator cuff tendinitis is treated conservatively with physical therapy, ice, and anti-inflammatory medication. Physical therapy aims to strengthen the other healthy rotator cuff muscles to reduce strain on the supraspinatus muscle. In conjunction, ice and anti-inflammatory medications aim to decrease the inflammation in the supraspinatus tendon. For those who are experiencing severe pain, a cortisone injection may be appropriate. Cortisone, a steroidal anti-inflammatory, is injected into the sub-acromial space, bathing the supraspinatus tendon in medication. These treatment measures both aim to decrease inflammation in the supraspinatus tendon so that it no longer experiences impingement against the base of the acromion.

 

For those who do not improve after conservative treatment, arthroscopic surgery may be recommended. This is an outpatient procedure; a patient will typically spend around three to four hours in the hospital or surgery center from the time of arrival to departure. The surgery itself takes approximately one hour. The surgeon will make three centimeter-long incisions in the shoulder. Through these incisions, a small camera is inserted into the shoulder joint and an evaluation of the entire shoulder is performed. Problems that may have been missed in a MRI image can be found at the time of surgery and treated accordingly. If there are no additional findings, a debridement of the joint and a subacromial decompression are both performed. A debridement involves a “cleaning up” of inflammatory tissue found in the joint using small instruments that cut, shave, chomp, or cauterize tissue. The subacromial decompression involves shaving the underside of the acromion to create space for the supraspinatus tendon to move. This is also done using a small deburring tool inserted through one of the incisions. After the procedure has been finished the surgeon closes the incisions using stitches.

 

After leaving the operating room patients typically spend one hour in the post-operative recovery area, and return home thereafter. A sling may be worn for one to two days after surgery and most patients control pain with mild pain relievers such as Motrin or Aleve. One week after the procedure, the surgeon will see the patient back in his or her office to examine the wounds and remove the stitches. Physical therapy is then prescribed to regain range of motion and strength in the shoulder.

 

Although outcomes and post-operative recovery time varies from patient to patient, the average recovery process from this surgery is as follows: After one month of physical therapy and icing most patients are able to perform most duties with the operative arm but may still experience slightly limited range of motion, shoulder weakness, and pain with overhead movements. At two months post-op most patients have often regained most of their range of motion but may still have strength gains to make. After three to five months, patients often have full range of motion and strength and exhibit no to minor symptoms of impingement syndrome.

 

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Impingement and rotator cuff tendonitis
Common injuries
  • rotator cuff injuries

  • nerve impingement

  • full and partial meniscus tears

  • patellofemoral pain syndrome

  • shoulder instability

  • disc displacement or disc herniation

  • degenerative disc disease

  • tendonitis and tensynovitis

 
Treatments
  • physical therapy

  • knee arthroscopy

  • shoulder arthroscopy

  • rotator cuff repair

  • pain management

  • cortisone injections

  • spinal injections

  • laminectomy, facetectomy and foraminotomy with decompression

  • cervical and lumbar fusion

  • total disc arthroplasty