Shoulder Impingement Tendinitis (Rotator Cuff Bursitis)

Shoulder Impingement Tendinitis (Rotator Cuff Bursitis) web based movie

The shoulder is a complex joint where several bones, muscles, and ligaments connect the upper extremity to the chest. The rotator cuff is a group of muscles and tendons that attach to the bones of the shoulder joint providing movement and stability to the shoulder. Inflammation of the rotator cuff tendons is called rotator cuff tendonitis or shoulder impingement tendonitis. “Impingement” means the tendon is rubbing on the bone. This rubbing irritates the rotator cuff tendons and causes thickening and swelling of the tendons and bursa. Shoulders with impingement tendinitis frequently have reduced clearance for the tendon to slide under the bone. The rotator cuff tendon is squeezed between the acromion process of the shoulder and the humeral head of the arm. This compression results in pain, tenderness, swelling, warmth and redness in the shoulder. As the conditions progresses, shoulder motion may be reduced.

Anatomy

Three bones, namely the upper arm bone (humerus), the shoulder blade (scapula) and the collar bone (clavicle) join together to make the shoulder joint.

The acromion is a protuberance of the shoulder bone or scapula. Ligaments are the thick strands of fibers that connect bone to bone. Ligaments connect the collar bone to the shoulder blade at the acromion process.

Bursa is a sac between the acromion process and the rotator cuff. It contains a lubricating fluid that prevents friction between the moving rotator cuff and the acromion.

Causes

Rotator cuff bursitis may be caused by repeated minor trauma such as overuse of the shoulder joint and muscles or significant trauma such as a fall.

Rotator cuff tendonitis may occur due to:

normal anatomic variants of the acromion including a downward set acromion, downward sloping acromion, and curvature of the front edge of the acromion
bony growth of the acromion process: this helps explain why your shoulder worked well as a teenager, possibly into your 20s or 30s, but then, for no apparent reason, starts hurting
bone spurs at the acromioclavicular joint
Inflammation of the bursa fluid (bursitis).
Degeneration of the tendons with age particularly above 40 years old
Overuse injury of the tendons: This occurs more often in people in certain professions and in sports requiring repetitive shoulder movement such as tennis players, swimmers, construction workers, and painters.
Trauma or injury: one hard throw can cause the problem to occur.

Diagnosis

Diagnosis involves physical examination by the doctor. X-rays are ordered to evaluate each patient’s individual anatomy, presence of fractures, or other causes of the pain such as arthritis and to check if shoulder impingement is due to a bone spur. Soft tissues such as muscle and tendons cannot be seen by X-ray so an ultrasound or MRI scan may be ordered to see if shoulder bursitis or shoulder tendinitis is involved.

Your doctor may give an injection of an anesthetic drug in the space below the acromion to see if it provides relief for the pain. If it does, it confirms that the pain was due to rotator cuff tendinitis or shoulder impingement.

Treatment

Treatment generally involves avoiding overhead activities totally for a time to rest the affected tendons and muscles. Non-steroidal anti-inflammatory medicines are given to reduce inflammation and thus help in decreasing pain and swelling. Some shoulder muscle strengthening exercises are also advised. If this does not provide relief an injection of local anesthetic and corticosteroid, a strong anti-inflammatory agent, may be given in the bursa below the acromion. Cortisone injections are generally not given if there is evidence of bone rubbing on the rotator cuff tendon. The condition usually takes a few months to recover completely. If conservative treatment measures do not resolve the problem, your doctor may recommend surgery.

The goal of surgery is to create more space for the rotator cuff by removing the front (anterior) edge of the acromion bone and the inflamed tissue of the bursa. The surgery is done arthroscopically. With arthroscopy, a minimally invasive surgical procedure, a tubular instrument called an arthroscope and other surgical tools are inserted into the shoulder joint through three small incisions. The arthroscope has a camera on the end that allows a large picture of the inside of the joint to be displayed on a video monitor for the surgeon. Once the problem is repaired, the incisions used in arthroscopy are sutured. Advantages of arthroscopy over open surgery are less pain, shorter recovery, and fewer complications.

Post-Operative

After the surgery pain medications are administered to relieve the pain and the arm is placed in a sling to allow healing. Your doctor will also prescribe physical exercises of the shoulder to get back functional mobility and strength in the shoulder muscle.