What is it?
The rotator cuff is made of four muscles and their tendons. The “cuff” acts as a cover around the top of the humerus (upper arm bone). The rotator cuff holds the humerus in place in the shoulder joint, allowing for lifting and rotation of the arm. The acromion is the front edge of the shoulder blade, sitting over and in front of the humeral head. When the acromion rubs on surface of the rotator cuff when the arm is lifted, it is called impingement. Impingement is common in both young athletes and all adult ages.
What causes impingement?
Impingement can be the result of:
- Bursitis, or inflammation of the bursa overlying the rotator cuff
- Tendonitis of the rotator cuff
- A partial tear of the rotator cuff
- Trauma
- Participating in sports or activities that require repetitive overhead movement
- Repetitive lifting
Symptoms:
- Sudden pain with lifting and reaching movements
- Difficulty placing the arm behind the back, such as with zippering or fastening a bra
- Minor pain present at rest and with activity
- Pain radiating from the front of the shoulder to the side of the arm
- Pain when lowering the arm from a raised position
- Stiffness
Diagnosis: Your physician will take a detailed history and will do a thorough examination of your shoulder. S/he will generally take an x-ray, which will show any evidence of osteoarthritis or the presence of a bone spur. Your physician may order an MRI to further visualize the rotator cuff and surrounding soft tissue. S/he may also perform an impingement test by injecting a local anesthetic into the bursa to confirm the diagnosis.
Treatment Options: Your physician will discuss both non-surgical and surgical treatment options with you. Initial treatment is generally non-surgical. Non-surgical treatment can be effective and results can be seen over the course of several weeks to months. Treatment may include:
- Rest and avoidance of overhead movements
- Non-steroidal anti-inflammatory medication
- Steroid injection
- Stretching/strengthening exercises
- Physical therapy
Surgical treatment may be recommended if pain has not been successfully relieved by non-surgical therapy. The goal of surgery is to remove what is causing the impingement on the rotator cuff, allowing the head of the humerus to move freely and to lift the arm without pain. The most common surgical procedure is called a subacromial decompression. Your physcian will discuss with you the procedure he will use to address your specific condition. In general, surgery will be done as an out-patient.
Rehabilitation following surgery: Your physician will discuss your rehab plans with you. In general, motion is encouraged immediately after surgery. Stretching and strengthening exercises can be started as soon as the immediate post operative discomfort has subsided. Rehab can be accomplished through a self directed program with handouts provided by your physician, or through formalized Physical Therapy, depending on individual needs. Full recovery is generally accomplished within 1-3 months following surgery.
