Rotator cuff impingement is one of the most frequently complained causes of pain in the shoulder. It is usually caused by over usage of the shoulder joint leading to inflammation of the tendons and bursa in the shoulder. It is a painful condition that limits shoulder movements making it difficult to carry out daily activities. Rotator cuff impingement can affect either one or both shoulder. If left untreated it can lead to thinning and tearing of the shoulder tendons. Rotator cuff impingement is also known as rotator cuff tendonitis, swimmer’s shoulder, tennis shoulder, shoulder impingement syndrome, pitcher’s shoulder and shoulder overuse syndrome.
Rotator Cuff Impingement: An Overview
The rotator cuff tendon is a tough tendon that connects the upper arm to the shoulder blade. It provides stability to the shoulder joint and helps in normal rotatory motion of upper arm and shoulder. The tendon of the rotator cuff and the shoulder muscles pass through a narrow space known as the subacromial space. With over usage of the shoulder joint, the tendon gets trapped in the subacromial space and repeatedly rubs against the bone on top called acromion. This causes bouts of pain and discomfort that worsens with arm movement.
Symptoms of Rotator Cuff Impingement
Rotator cuff impingement is characterised by difficulty and discomfort with shoulder movements such as reaching behind the back, and raising arm above the head etc. The symptoms of Rotator cuff impingement include:
- Shoulder pain at rest and with activity.
- Difficulty taking arm behind the back and above the head is one of the symptoms of Rotator cuff impingement.
- Tenderness radiating from the shoulder joint to the arms.
- Sudden onset of excruciating pain with certain shoulder movements can be a symptoms of Rotator cuff impingement.
- Loss of muscle strength.
Over a period of time Rotator cuff impingement leads to muscle weakness and tenderness. In advanced stages it can result in a condition called as rotator cuff tear and rupture of the biceps muscles.
Prognosis of Rotator Cuff Impingement
Rotator cuff impingement is a treatable condition. With adequate rest, recommended exercises and other home measures it may take few weeks to few months to completely resolve the condition. The prognosis of rotator cuff impingement depends on the age of the person, extent of being physically active and size and onset of the tear.
Causes of Rotator Cuff Impingement
Rotator cuff impingement is more common among middle-aged population and athletes, who use their arm dynamically for activities like construction work, swimming, painting and playing basketball, tennis, badminton etc. It is caused primarily due to narrowing of the subacromial space, possibly caused by:
- Bony spurs in the subacromial space.
- Inflammation of the rotator cuff tendon can also cause Rotator cuff impingement.
- Inflammation of the bursa i.e. the fluid filled sac between the tendon and bone.
- Calcium deposits on the tendon can cause Rotator cuff impingement.
- History of trauma, injury or over usage of the shoulder.
Risk Factors for Rotator Cuff Impingement
The risk factors include:
- Keeping arm in unchanged position for prolonged period of time can be a risk factor for Rotator cuff impingement.
- Sleeping on same arm every day.
- Activities such as playing tennis, baseball, swimming and weight lifting.
- Rotator cuff tear.
Complications for Rotator Cuff Impingement
Without treatment, rotator cuff impingement can cause permanent stiffness and weakness which in turn can lead to degenerative disorders, dislocation and frozen shoulder.
Diagnosis of Rotator Cuff Impingement
Diagnosis of rotator cuff impingement is done by taking an appropriate medical history followed by a thorough physical examination by an orthopaedist. There are specific arm tests that are done by a specialist for correct detection of the condition. Imaging tests such as x-rays, magnetic resonance imaging (MRI), computed tomography (CT), ultrasonography, and arthrogram are considered for further evaluation and management.
Treatment of Rotator Cuff Impingement
Once the condition is rightfully diagnosed, the following options can be considered based on the severity:
- Anti-inflammatory Medications to Treat Rotator Cuff Impingement: Pain medications (NSAIDS) such as Aspirin, Acetaminophen, Naproxen or Ibuprofen can be prescribed for management of pain and discomfort.
- Steroid Injections for Treating Rotator Cuff Impingement: If symptoms do not improve with pain medications, corticosteroid injections or other gel injections can be considered for bringing about a reduction in inflammation.
- Physical Therapy to Treat Rotator Cuff Impingement: Stretching exercises and physical manipulation of the shoulder joint by an experienced professional can be helpful in improving the range of motion.
- Occupational Therapy for Treating Rotator Cuff Impingement: Occupation therapy focuses on improving daily activities that affects the shoulder movement.
- Surgical Intervention for Rotator Cuff Impingement: In advanced cases, traditional open surgery or arthroscopic surgery is done for repair and reattachment of the tendons.
How to Take Care of Rotator Cuff post Impingement?
- Adequate Rest post Rotator Cuff Impingement: It is advised to avoid activities such as overhead arm movements, excessive physical activities etc. that may worsen the symptoms until the symptoms resolve.
- Ice Application in the Rotator Cuff post Impingement: Applying ice over the affected shoulder can help to ease the pain and discomfort.
- Exercises as Post Care following Rotator Cuff Impingement: Though adequate rest is recommended, some amount of exercise under supervision of a physiotherapist is suggested to avoid joint stiffness and improve range of motion.
Rotator cuff impingement is a condition that affects the tendons and muscles of the shoulder that help in shoulder movement. It is commonly seen in athletes and other individuals with need for frequent arm movements. It is generally treated with anti-inflammatories and steroids in early stages and may require surgical correction in later stages. Besides these, stretching exercises, physical therapy and occupational therapy are beneficial.
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