Shoulder Impingement and Rotator Cuff Tendinitis

The rotator cuff is an exceedingly common source of shoulder pain. The rotator cuff is comprised of 4 muscles and tendons that work in concert to keep the ball (humeral head) centered on the socket (glenoid).

The anatomy of shoulder impingement and rotator cuff tendinitis

The bony contents of your shoulder joint include the ball (humeral head), socket (glenoid/scapula), and clavicle.

The rotator cuff muscles work to keep the ball centered on the socket to allow the other big muscles around the shoulder to work in a mechanically advantageous way.

Additionally, there is a fluid-filled sac called the bursa located in the space between your rotator cuff and bone on top of the shoulder (acromion). The bursa prevents a soft structure, like a tendon, from rubbing against a hard surface, like a bone.

What is rotator cuff tendinitis?

• Tendinitis: an irritated or inflamed tendon
• Bursitis: an irritated or inflamed bursal sac
• Impingement: when you raise your arm above shoulder level, the space available for the rotator cuff functionally narrows. The acromion and coracoacromial ligament can rub against, or impinge upon, the rotator cuff tendons and bursa. This can cause pain and shoulder dysfunction.

What causes rotator cuff tendinitis?

In younger patients, rotator cuff tendinitis is most commonly associated with overuse combined with poor shoulder mechanics. Patients who regularly perform overhead activities are the most susceptible.

In older patients, rotator cuff tendinitis may of course be attributable to overuse, but frequently arises without apparent cause.

Symptoms of rotator cuff tendinitis

Early symptoms may be mild and frequently include:

• Mild pain present mainly with activity
• A dull ache on the side of the shoulder
• Sudden, sharp pain with lifting or reaching
• Sport-specific pain, such as discomfort with overhead throwing or serving a tennis ball

As the problem worsens, symptoms may include:

• Pain at night when trying to sleep
• Decreased strength and motion (stiffness)
• Difficulty with reaching behind the back and across the body

Non-surgical treatment for rotator cuff tendinitis

A large majority of these cases are successfully treated without surgery. The components of non-operative treatment selected for you depend on the chronicity and severity of your symptoms.

Treatment will often include:

• Rest: avoiding aggravating activities is critical in allowing the tendon to calm down
• Non-steroidal anti-inflammatory (NSAIDs) medicines: NSAIDs such as Ibuprofen, Aleve, Meloxicam, etc, assist in reducing pain and inflammation and better allow patients to participate in a rehabilitation program
• Steroid injection: a steroid injection into the subacromial space (the space above the rotator cuff) is effective at reducing pain, inflammation, and bursitis. Again, this allows patients to more actively participate in a rehabilitation program.
• Physical therapy: either a home exercise program or formal therapy with a trained physical therapist is critical to restoring normal motion and ultimately normal strength to your shoulder.

Surgical treatment for rotator cuff tendinitis

If after prolonged non-operative treatment, including a steroid injection and physical therapy, your pain persists, and your anatomy can be corrected in a way that would relieve your pain, Dr. Dare may recommend surgery.

The goal of surgery is to address all potential sources of pain. In shoulder impingement, this most frequently involves arthroscopic removal of the “impinging” bone on the undersurface of the acromion, in addition to removal of the inflamed bursa. If your physical examination warrants it, surgery may also address a painful acromioclavicular joint and/or biceps tendon.

Post-operative rehabilitation

You will be placed in a sling to be used for comfort for 1-2 weeks. Home exercises and physical therapy will begin shortly after surgery to restore motion and strength.

Complete pain relief is often obtained at 2 to 4 months, but patients make gains out to 1 year.

If you think you may be suffering from rotator cuff tendinitis, book an appointment today with Dr. David Dare. Dr. Dare is a fellowship-trained orthopedic surgeon specializing in sports medicine and shoulder surgery. His primary goal is to develop an effective treatment plan using the least invasive techniques to relieve your shoulder pain, restore function, and get you back to feeling your best. Call 919.781.5600  or fill out a form on this page.