In 2008, close to 2 million people in the United States went to their doctors because of a rotator cuff problem.
Shoulder Impingement Syndrome
Shoulder impingement syndrome is a common cause of shoulder pain and refers to group of conditions that causes pain in the shoulder:
- Impingement: Irritation of the rotator cuff tendon due to rubbing against the bone.
- Bursitis: Inflammation/ irritation of the gel cusion between the rotator cuff tendon and bone
- Tendinitis: Inflammation/irritation of the rotator cuff tendons.
Rotator Cuff Tears
When there is a rotator cuff tendon is torn, there may be pain as well as weakness of the shoulder. Rotator cuff tears can be acute and degenerative, with degenerative being the most common type. Acute tears occur typically after trauma, such as a fall. Degenerative tears occur as a result of general “wear and tear” on the tendon over time. As a result, people over the age of 40 are at an increased risk for developing a degenerative tear.
Symptoms & Causes
Typically, patients complain of pain in the front of the shoulder, which worsens when lifting the arm up. When symptoms are severe, there may be pain with any movement of the shoulder.
Those involved with activities requiring repetitive use of the arms above their shoulders are more susceptible to this condition. Athletes who are participate in sports such as tennis, volleyball, baseball, swimming, commonly develop this type of injury. People who have a bone spur in their shoulder that “impinges” on the rotator cuff tendon can also develop these symptoms. Sometimes, it occurs with no apparent cause.
A thorough history and physical examination is required to make a proper diagnosis. This helps to differentiate between a true shoulder issue and other medical conditions that can cause similar symptoms.
Additional diagnostic testing may be recommended, such as an X-ray or an MRI of the shoulder, particularly if there is a concern for a rotator cuff tear that is not responding to conservative treatment.
The goal of treatment is to reduce pain and restore function. Most cases of rotator cuff injuries can be treated without surgery. In some instances, however, non-surgical treatment may take several weeks to months.
Relative rest and avoidance of exacerbating activities is recommended when the shoulder is still symptomatic.
Non-steroidal anti-inflammatory medications such as ibuprofen or naproxen can be effective in treating the pain and swelling from a rotator cuff injury condition.
The goal of shoulder therapy program is to restore normal shoulder motion and then shoulder stabilization and strengthening program for the rotator cuff muscles.
Ultrasound Guided Shoulder Injection
If the pain persists despite more conservative treatment, an ultrasound guided cortisone injection can be very effective in calming down the inflammation in the shoulder. An anesthetic and a cortisone preparation are placed in the affected area to bathe the tendon and bursa region. Cortisone acts as a very effective anti-inflammatory medicine that helps to quickly reduce pain and inflammation. With the advent of musculoskeletal ultrasound imaging, ultrasound guidance has been shown to significantly increase the accuracy of such injections.
Surgery may be indicated in cases where your symptoms are not improving with conservative care, are persistent for more than 6-12 months. If there is a rotator cuff tear, surgery may be indicated earlier if you have a large tear or if you have significant weakness and loss of function of the shoulder.