The rotator cuff is a group of four muscles (they are infraspinatus, supraspinatus, Teres minor and subscapularis) around the shoulder joint that work synergistically to enable shoulder joint movement. The tendons of these muscles make a common rotator cuff tendon that extends under the subacromial space and attaches to the head of the humerus. The subacromial bursa is a fluid filled sac that lubricates the movement of rotator cuff and has pain sensors leading to pain in rotator cuff disorders.
What Is Rotator Cuff Impingement?
The impingement of rotator cuff occurs when the rotator cuff tendon and the subacromial bursa are pinched in the subacromial space, leading to inflammation and swelling. The impingement worsens when the arm is raised away from the body’s side.
Causes of impingement include:
- Inflammation of the bursa due to minor injury,
- Repetitive movements like strenuous exercise or
- Calcification of the ligaments in the coracoacromial
- Old age and diseases like arthritis cause bone deformity which leads to the formation of spurs on the acromion, further narrowing the subacromial space.
- Overhead movements of the shoulder joint worsen the impingement.
Impingement can be divided in three grades:
- Grade I: Inflammation of the bursa and tendon
- Grade II: Thickening of the tendon and scarring of the bursa
- Grade III: Rotator cuff starts to degenerate and tears are perceptible.
How to Diagnose Rotator Cuff Impingement
A common cause of shoulder pain is an impinged rotator cuff, crushing of the rotator cuff tendon and the subacromial bursa due to repeated overhead activity of the shoulders. In order to find out if you have impinged rotator cuff, you have to know the symptoms and diagnosis method.
- Shoulder muscle weakness
- Difficulty and pain in raising arms over the back and head
- If a rotator cuff tendon injury is not instantly managed, the rotator cuff tears, leading to completely inability to raise the arm
- In severe cases, persistence of the impingement results in the rupturing of the biceps
The doctor may order the following tests:
- Starting with a physical examination, your doctor will observe tenderness on your shoulder area indicative of a Rotator cuff impingement. It is painful to raise arms overhead and the shoulder exhibits weakness when placed in particular positions.
- An X-ray may also be taken to see if there are spurs on the bones of the shoulder area.
- Ultrasound utilizes sound waves to create an image of the shoulder joint, which can show rotator cuff tear.
- MRI of the shoulder can displays swelling and rotator cuff tear.
- In a jointed X-ray, the shoulder joint is injected with a contrast dye and then a combination of X-ray, CT and MRI scans are used to get an enhanced picture of the region, helping doctors indemnity small rotator cuff tears.
How to Deal With Rotator Cuff Impingement
Treatment for impingement of rotator cuff varies from oral anti-inflammatory medications, physical therapy, lifestyle changes to prevent further damage and cortisone-type injections for more severe cases.
The most common treatment is oral anti-inflammatory medicines like aspirin, ibuprofen and naproxen. It is important to remember that oral anti-inflammatory medicines need to be taken for a time span of 8 weeks to fix the actual underlying cause of the disorder. A short term medication therapy may rid the patient of symptoms but if the cause is not treated properly the symptoms will recur.
Different anti-inflammatory medicines are used until a patient responds to an effective one. If all medicines proved to be ineffective and the rotator cuff impingement symptoms persist, then the doctor prescribes cortisone-like infection. Cortisone is an anti-inflammatory agent but should be used sparingly as it has tendon and muscle weakening side effects.
2. Proper Exercise
Exercise along with medication is very effective in improving the condition. Stretching muscles daily when having warm water shower and moving thumb behind the back and up are useful for easing the pain. Injured arm should not be used for repetitive activities like painting, vacuuming, car washing, etc. It is suggested to avoid moves where elbow is moved above the level of shoulders.
Doctors perform surgery when nonsurgical treatments are not working. More space for the rotator cuff is created by removing the inflamed part of bursa. A part of acromion may also be removed by anterior acromioplasty. Doctor will perform these by open technique or arthroscopy.
Open technique in surgical procedure involves incision on the shoulder front which allows the doctor to observe rotator cuff and acromion. In arthroscopy shoulder is examined through fiberoptic scope which enters the skin through 2 or 3 small punctures and guided by a video monitor. Doctor observes through the monitor and removes the problematic part.