SHOULDER TENDONITIS / IMPINGEMENT
Why do I have problems with shoulder impingement?
Usually, there is enough room between the acromion and the rotator cuff so that the tendons slide easily underneath the acromion as the arm is raised.
But each time you raise your arm, there is a bit of rubbing or pinching on the tendons and the bursa.
This rubbing or pinching action is called impingement.
Impingement occurs to some degree in everyone's shoulder. Day-to-day activities that involve using the arm above shoulder level cause some impingement.
Usually it doesn't lead to any prolonged pain.
But continuously working with the arms raised overhead, repeated throwing activities, or other repetitive actions of the shoulder can cause impingement to become a problem. Impingement becomes a problem when it causes irritation or damage to the rotator cuff tendons.
Raising the arm tends to force the humerus against the edge of the acromion.
With overuse, this can cause irritation and swelling of the bursa.
If any other condition decreases the amount of space between the acromion and the rotator cuff tendons, the impingement may get worse.
Bone spurs can reduce the space available for the bursa and tendons to move under the acromion.
Bone spurs are bony points.
They are commonly caused by wear and tear of the joint between the collarbone and the scapula, called the acromioclavicular (AC) joint.
The AC joint is directly above the bursa and rotator cuff tendons.
Tendonitis is an inflammation of the shoulder tendons.
The signs of inflammation are pain, warmth, redness, tenderness to touch, and loss of function.
Shoulder tendonitis (often called Rotator Cuff Tendonitis) can occur when the rotator cuff is overloaded, fatigued, traumatized, and with age-related degenerative changes.
X-rays may show a hook or spur that increases the odds that you will pinch the rotator cuff tendons.
Treatment for impingement or rotator cuff tendonitis usually involves rest, anti-inflammatory medications like ibuprofen, physical therapy to restore proper strength and movement, and less often, a cortisone injection.
SymptomsWhat does impingement syndrome feel like?
Impingement syndrome causes generalized shoulder aches in the condition's early stages.
It also causes pain when raising the arm out to the side or in front of the body.
Most patients complain that the pain makes it difficult for them to sleep, especially when they roll onto the affected shoulder.
A reliable sign of impingement syndrome is a sharp pain when you try to reach into your back pocket.
As the condition worsens, the discomfort increases.
The joint may become stiffer. Sometimes a catching sensation is felt when you lower your arm.
Weakness and inability to raise the arm may indicate that the rotator cuff tendons are actually torn.
POSSIBLE TREATMENT GOALS
- Decrease Risk of Reoccurrence
- Improve Fitness
- Improve Muscle Strength and Power
- Increase Oxygen to Tissues
- Improve Proprioception
- Improve Range of Motion
- Self-care of Symptoms
- Improve Tolerance for Prolonged Activities
RehabilitationWhat should I expect after treatment?
Nonsurgical RehabilitationEven if you don't need surgery, you may need to follow a program of rehabilitation exercises.
Your doctor may recommend that you work with a physical or occupational therapist.
Your therapist can create an individualized program of strengthening and stretching for your shoulder and rotator cuff.
It is important to maintain the strength in the muscles of the rotator cuff.
These muscles help control the stability of the shoulder joint.
Strengthening these muscles can actually decrease the impingement of the acromion on the rotator cuff tendons and bursa.
Your therapist can also evaluate your workstation or the way you use your body when you do your activities and suggest changes to avoid further problems.
After SurgeryRehabilitation after shoulder surgery can be a slow process.
You will probably need to attend therapy sessions for several weeks, and you should expect full recovery to take several months.
Getting the shoulder moving as soon as possible is important. However, this must be balanced with the need to protect the healing muscles and tissues.
Your surgeon may have you wear a sling to support and protect the shoulder for a few days after surgery.
Ice and electrical stimulation treatments may be used during your first few therapy sessions to help control pain and swelling from the surgery.
Your therapist may also use massage and other types of hands-on treatments to ease muscle spasm and pain.
Therapy can progress quickly after a simple arthroscopic procedure.
Treatments start out with range-of-motion exercises and gradually work into active stretching and strengthening. You just need to be careful to avoid doing too much, too quickly.
Therapy goes slower after open surgery in which the shoulder muscles have been cut.
Therapists will usually wait up to two weeks before starting range-of-motion exercises. Exercises begin with passive movements.
During passive exercises, your shoulder joint is moved, but your muscles stay relaxed. Your therapist gently moves your joint and gradually stretches your arm. You may be taught how to do passive exercises at home.
Active therapy starts four to six weeks after surgery.
You use your own muscle power in active range-of-motion exercises. You may begin with light isometric strengthening exercises. These exercises work the muscles without straining the healing tissues.
At about six weeks you start doing more active strengthening.
Exercises focus on improving the strength and control of the rotator cuff muscles and the muscles around the shoulder blade.
Your therapist will help you retrain these muscles to keep the ball of the humerus in the socket. This helps your shoulder move smoothly during all your activities.
Some of the exercises you'll do are designed get your shoulder working in ways that are similar to your work tasks and sport activities.
Your therapist will help you find ways to do your tasks that don't put too much stress on your shoulder. Before your therapy sessions end, your therapist will teach you a number of ways to avoid future problems.