Rotator Cuff Impingement

The shoulder is the most mobile joint in the human body with a complex arrangement of structures working together to provide the necessary movement. The shoulder is a ball-and-socket joint made up by the humerus (the ball) and the glenoid (the socket). A strong network of soft tissues, muscles, and bones work cohesively to provide movement and stability to the shoulder. The head of the humerus fits into a shallow socket in the scapula, called the glenoid fossa, while the shoulder capsule, a strong connective tissue, surrounds the shoulder joint. Synovial fluid lubricates the joint and the shoulder capsule to ease the movement of the shoulder.

Overview

The rotator cuff is a group of four muscles and their tendons that originate on various parts of the scapula (shoulder blade) and insert onto the humerus. The rotator cuff muscles work together to provide movement, rotation, and stability to the shoulder. One of the most commonly injured rotator cuff muscles is the supraspinatus, which runs over the top of the shoulder, just underneath the lateral-most projection of the scapula, called the acromion. Over time, bone spurs can form underneath the acromion, causing the rotator cuff to become frayed and damaged, or impinge. In some cases, the rotator cuff partially or completely tears, causing pain and loss of motion and strength. This can be likened to a rope become frayed over time as it rubs against a hard, jagged surface.

When one or more of the rotator cuff tendons is torn, it no longer attaches to the head of the humerus completely. In most cases, torn rotator cuff tendons begin by fraying and as the damage progresses, the tendon can completely tear.

Symptoms

Individuals who are experiencing a shoulder impingement or rotator cuff pathology, typically have the following symptoms:

  • Pain when raising the arms over the head
  • Pain when laying on or reaching back with the injured shoulder
  • Limited or restricted range of motion in the shoulder joint
  • A sense of weakness
  • Pain at the side of the shoulder / upper arm

If pain, loss of movement, or weakness persists, a visit to a physician is highly recommended to evaluate for a possible rotator cuff tear.

Diagnosis

Whether it be rotator cuff tendinopathy, tendinitis, impingement, or tearing, rotator cuff tendinopathy can be diagnosed with the help of physical examination and imaging studies. The physician will examine the shoulder to test the range of motion within the shoulder joint as well as the strength of the muscles. The physician may order X-rays to rule out arthritis and look for any changes in the bone to indicate injury or predisposition to certain conditions, such as bone spur formation. Additionally, the physician may order a CT or MRI scan to determine the amount of damage to the rotator cuff tendon.

There are two different types of tears:

Partially Torn Rotator Cuff - This type of problem denotes that there has been some damage to the rotator cuff, such as fraying or partial tears inside of the tendon, but that the tendon has not completely torn off from its attachment to the humerus.

Completely Torn Rotator Cuff: This type of tear is a full-thickness tear where the tendon has completely torn off from the humerus.

Treatment

Whether it be rotator cuff tendinopathy, tendinitis, impingement, or tearing, rotator cuff tendinopathy can be diagnosed with the help of physical examination and imaging studies. The physician will examine the shoulder to test the range of motion within the shoulder joint as well as the strength of the muscles. The physician may order X-rays to rule out arthritis and look for any changes in the bone to indicate injury or predisposition to certain conditions, such as bone spur formation. Additionally, the physician may order a CT or MRI scan to determine the amount of damage to the rotator cuff tendon.

There are two different types of tears:

Partially Torn Rotator Cuff - This type of problem denotes that there has been some damage to the rotator cuff, such as fraying or partial tears inside of the tendon, but that the tendon has not completely torn off from its attachment to the humerus.

Completely Torn Rotator Cuff: This type of tear is a full-thickness tear where the tendon has completely torn off from the humerus.

Recovery

Regardless of the treatment approach taken, patients go through a rehabilitation program which includes physical therapy exercises that are crucial to restore range of motion. Each patient is unique, so the therapy program will vary based on his/her level of pain, extent of injury, and desired level of activity they would like to return to. Recovery after surgery can take anywhere from six weeks to six months depending on the complexity of the procedure, but the individual's commitment to following all the restrictions set forth by the surgeon and the exercises prescribed by the physical therapist is the most important factor in returning to all the desired activities.

Disclaimer

CALL 911 IMMEDIATELY IF YOU ARE HAVING A MEDICAL EMERGENCY!

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