Impingement Syndrome or Rotator Cuff Tendinitis

Impingement Syndrome or Rotator Cuff Tendinitis: The most common complaint made by individuals is pain in the shoulders. There can be many reasons because of which an individual may develop pain in the shoulder. The shoulder is made up of several joints which in combination with tendons and muscles facilitate smooth motion of the shoulder. Since there are numerous structures with which the shoulder is made up of, it makes the shoulder vulnerable to several injuries. One such injury is Rotator Cuff Tendinitis, also called as Impingement Syndrome.

Impingement Syndrome or Rotator Cuff Tendinitis

In this article, we will read in detail about the following:

  • Causes of Impingement Syndrome or Rotator Cuff Tendinitis
  • Various symptoms experienced by individuals suffering from Impingement Syndrome or Rotator Cuff Tendinitis
  • The various treatments rendered for Impingement Syndrome or Rotator Cuff Tendinitis
  • Various exercises that an affected individual can do to relieve symptoms of Impingement Syndrome or Rotator Cuff Tendinitis

How Do We Define Impingement Syndrome Or Rotator Cuff Tendinitis?

Impingement Syndrome or Rotator Cuff Tendinitis typically affects tendons and muscles which facilitate smooth movement of the shoulder joint. In this condition, the tendons of the shoulder get inflamed as a result of injuries or other medical conditions.

Causes of Impingement Syndrome Or Rotator Cuff Tendinitis

Impingement Syndrome or Rotator Cuff Tendinitis develops gradually over a period of time. This condition can develop if the shoulder is kept in one position for a prolonged period of time, sleeping on shoulder, or performing activities requiring extension of arm overhead.

Impingement Syndrome or Rotator Cuff Tendinitis is most common in athletes who play sports requiring extension of the arm overhead like tennis, volleyball, basketball etc. Impingement Syndrome or Rotator Cuff Tendinitis is also known by the name of Swimmer's Shoulder, Pitcher's Shoulder, or Tennis Shoulder.

At times, Impingement Syndrome or Rotator Cuff Tendinitis develops without any clear cut etiology. Most affected individuals tend to regain full function of shoulder without any pain with adequate treatment and exercises.

Symptoms Of Impingement Syndrome Or Rotator Cuff Tendinitis

Individuals affected with Impingement Syndrome or Rotator Cuff Tendinitis tend to have gradual worsening of symptoms. Some of the initial symptoms can be relieved with rest but over a period of time symptoms become constant. Some of the common symptoms of Impingement Syndrome or Rotator Cuff Tendinitis are:

  • Swelling and pain in front of shoulder and side of arm
  • Pain in the shoulders with raising of the arm
  • An audible click with raising the arm
  • Stiffness of shoulders
  • Excruciating pain the shoulders which can even wake an individual from sleep
  • Pain with reaching behind the back
  • Reduced motion and strength of the arm.

Diagnosis of Impingement Syndrome Or Rotator Cuff Tendinitis

If an individual presents to a physician with the above noted symptoms, then the physician at first will examine the shoulder for any type of pain or palpable tenderness. The physician will also check for the mobility of the shoulder by moving the shoulders in certain directions.

The physician will then check for the strength of the shoulder by offering resistance to the shoulder. A neck examination may also be performed to look for a pinched nerve or presence of arthritis which also have similar symptoms to that of Impingement Syndrome or Rotator Cuff Tendinitis.

Apart from a physical examination, radiological studies to include x-rays, ultrasound, or MRI of the shoulder to look for inflammation or rupture of tendons may also be ordered for confirmatory diagnosis of Impingement Syndrome or Rotator Cuff Tendinitis.

Treatment For Impingement Syndrome Or Rotator Cuff Tendinitis

Initial treatment for Impingement Syndrome or Rotator Cuff Tendinitis is usually conservative to relieve swelling and inflammation and involves the following:

  • Avoiding activities which aggravate the pain
  • Application of cold packs to shoulder about thrice daily
  • Use of NSAIDs like ibuprofen or naproxen.

Additionally the following may also be done to relieve symptoms:

Physical Therapy: This initially consists of stretching exercises and other passive exercises for restoration of range of motion and reduction of pain. Once the pain is brought under control, exercises are started for regaining strength of the shoulder.

Use of Steroids: If the above mentioned conservative treatments fail to relieve symptoms then steroid injections may be used to reduce symptoms. The function of the steroid injection is to reduce inflammation and control the pain.

Surgery: If all forms of conservative treatments and steroid injections fail to relieve symptoms, then a surgical route is taken in the form of a rotator cuff surgery, which usually results in complete relief of symptoms. This is done via arthroscopy in which an instrument called an arthroscope is inserted which has a camera to look at the damaged structure. This is the most non-invasive method of treating Impingement Syndrome or Rotator Cuff Tendinitis.

Usually, open shoulder surgery is not necessary for Impingement Syndrome or Rotator Cuff Tendinitis. However, this route can be taken in cases of a large rupture of the tendon.

Watch 3D Video of Shoulder Joint Therapeutic Arthroscopy:

Exercises For Impingement Syndrome Or Rotator Cuff Tendinitis

The main goal of performing exercises is to reduce inflammation and pain: The exercises involve stretching and strengthening the shoulders.

Stretching Exercises For Shoulders

Some Of The Exercises Done To Stretch The Shoulder Include:

Posterior Stretching: To do this exercise, you need to stand upright and cross an arm across the body; now, using the other arm try and pull the elbow of the affected arm towards the other shoulder as shown in the picture. Hold this position for about half a minute

Anterior Stretching: To do this exercise, stand upright keeping the back straight. Now, clasp the hands behind the back. Now try and lift the arm slowly away from the body in an upward direction. Hold this position for about half a minute

Pendulum Exercises: To do this exercise, bend down such that the arms are dangling. You may need to hold a table for support. Gently transition your entire body weight from the left foot to the right in a circular fashion so as to move the arm in a circular fashion. Now do the same thing in the opposite direction. Repeat this about five times. Now, in the same position with the hands dangling down try and move the arm forwards and backwards first and then in a sideways motion.

Wall Stretches: To do this exercise, place the palm, elbow, and shoulder of an arm against a wall. With the arm in contact with the wall, breathe out and gently turn the body around and feel a sensation of stretching in the biceps and pectoralis muscles.

Strengthening Exercises For Shoulders:

Internal Rotation Exercise Using a Band: To do this exercise you need to do the following:

  • You need to begin with a band which is attached to a fixed point.
  • Now, hold the other end of the band in one hand keeping the elbows bent and the upper arm in a sideways position.
  • Keeping elbow by the side, now try and move the hand towards the stomach as much as possible without aggravating pain.
  • Now gradually return back to the original position.

External Rotation Exercise Using a Band: For this, plug the band around some sort of post with its height equal to that of the elbow. Stand on the left side of the band and grasp the band with the right hand all the while keeping the elbow pressed to the side without moving it. Now rotate the arm backwards as far as possible without increasing pain and gradually come back to starting position.

Isometric Shoulder Exercises

  • Isometric Shoulder Flexion: In this exercise, the arm is moved a bit in front of body with the fists just in contact with a wall. Hold this position for about 10 seconds.
  • Isometric Extension: In this exercise, you need to stand with the back to the wall with the arms just behind. Now, try and push the arm backwards against the wall. You need to do this for about 10 seconds.
  • Isometric Abduction: The athlete stands side-on to a wall and tries to push the arm out to the side against the wall. Hold for 5-10 seconds.
  • Internal/Medial Rotation: In this, the arm is bent at the elbow and the wrist is pushed against a wall. This position needs to be held for about 10 seconds.
  • External/Lateral Rotation: The arm is bent at the elbow and the wrist pushed back against the wall as if trying to rotate outwards. Hold for 5-10 seconds.

Wall Pushups: For this exercise, you need to stand about 2 feet away from a wall with outstretched hands facing the wall. Now lean the body against the wall with the hands in contact with the wall. Now, push the body back and come back to the starting position.

Home Remedies For Impingement Syndrome Or Rotator Cuff Tendinitis

Some of the things that an affected individual can do at home itself to relieve the symptoms of Impingement Syndrome or Rotator Cuff Tendinitis are:

  • Good sitting posture
  • Avoiding repetitive use of arms overhead
  • In case repetitive activities cannot be avoided then taking frequent breaks
  • Avoiding sleeping on same side every night
  • Avoiding carrying handbag on only one shoulder.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: November 18, 2014

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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