Shoulder pain is common with many injuries classified as impingement syndrome or rotator cuff tears. Shoulder impingement syndrome occurs when the tendons of the rotator cuff are compressed as the shoulder is moving. This results in damage to the tendons and the bursa, a sac on top of your shoulder that allows the tendons to move freely. Pain is experience when the arm is raised awaY from the body. Impingement can develop over time with repetitive motions or because of an injury. A rotator cuff is a group of tendons in the shoulder joint that provides support and enables a wide range of motion. A major injury to these tendons may result in rotator cuff tears. It is one of the most common causes of shoulder pain in middle-aged and older individuals.
There are three categories of impingement:
- Grade I - marked by inflammation of the bursa and tendons
- Grade II - progressive thickening and scarring of the bursa
- Grade III - rotator cuff degeneration and tears are evident
Symptoms
A rotator cuff tear causes weakness in the shoulder and pain that can hinder daily activities such as reaching above the head. If the tendons in the shoulder are injured, this will cause the bursa to also become inflamed. If there is a tear in a rotator cuff tendon, the tendon will break away from the head of the humerus. A tear is typically a result of a certain movement, such as lifting a heavy object, or it can be caused by degeneration. The two types of tears are partial and full, partial means that the tendon is damaged but full is when the tendon is completely separated from the bone. If a tear occurs from an incident, there will be sudden and intense pain, and possibly a popping of the tendon. If the tear develops over time, weakness in your shoulder will be noticed and an increase of pain. A rotator cuff tear causes severe pain, weakness of the arm and crackling sensation on moving the shoulder in certain positions. There may be stiffness, swelling, loss of movement and tenderness in the front of the shoulder.
Diagnosis
A rotator cuff tear is diagnosed by physical examination. X-rays and MRI are usually ordered for best view of the injury.
Treatment
The severity of the tear determines the treatment.
Conservative treatment includes:
- Rest of the shoulder
- Anti-inflammatory injections—Cortisone, Platelet-rich Plasma or Regenerative Cell Therapy/ Orthobiologics
- Injection of a steroid (cortisone) and a local anesthetic in the subacromial space to relieve inflammation and pain
- Shoulder sling may be recommended
- Physical therapy
Surgical procedures may be recommended if experienced the symptoms are experienced for longer than six months or if the tear is too large to heal with conservative treatment. Rotator cuff repair may be performed by open or arthroscopic surgery. In arthroscopy, the space for rotator cuff tendons will be increased and the cuff tear is repaired. Anchor sutures help in attaching the tendons to the shoulder bone. Following the surgery motion and strengthening exercises may be recommended in physical therapy.