Rotator Cuff Tendon Impingement

Conditions Basics

What are rotator cuff disorders?

The rotator cuff is a group of tough, flexible fibers (tendons) and muscles in the shoulder. Rotator cuff disorders include:

• Irritation or damage to the tendons (tendinopathy, sometimes called tendinitis).
• Inflammation or irritation of a bursa (bursitis). In the shoulder, a bursa is a small, fluid-filled sac that serves as a cushion between the tendons and the bones.
• Impingement. This means that a tendon is squeezed or rubbed against bone.
• Calcium buildup in the tendons. The buildup can cause a painful condition called calcific tendinopathy.
• Partial or complete tears of the rotator cuff tendons.

What causes it?

Most rotator cuff disorders are caused by a mix of overuse and normal wear and tear.

Overuse.

Activities in which you use your arms above your head a lot—such as tennis, swimming, or house painting—can lead to rotator cuff problems. Even normal motions made often over a long period can stress or injure the rotator cuff.

Normal wear and tear.

Using your shoulder for many years slowly damages the rotator cuff. As you age, everyday activities can lead to changes in the rotator cuff. These changes include thinning and fraying of the tendons and reduced blood supply.

It takes great force to tear a healthy rotator cuff tendon. This can happen during sports, an accident, or a severe fall. But even a simple movement like lifting a suitcase can cause a rotator cuff tear in an older adult or someone whose shoulder is already damaged.

What are the symptoms?

A rotator cuff disorder causes pain and weakness in your shoulder. It may hurt to do everyday activities, such as combing your hair, tucking in your shirt, or reaching above your head.

Because of the pain, you may try not to use your arm. And that can cause even more weakness and stiffness in the shoulder.

Symptoms of rotator cuff tendinopathy

With tendinopathy (damage or irritation to the tendon), the pain usually starts bit by bit, over the side of the shoulder and the upper arm.

• Your shoulder and arm aren't that weak, but it hurts to use them.
• The pain may spread down the outside of the upper arm, even to the elbow.
• The pain may be worse at night. It may keep you awake, especially if you lie on that side.
• Lifting the arm to the side or to the front makes the pain worse.

Over time, the pain may get worse, or you may have constant pain. In some cases, this is because you actually have one or more small tendon tears.

Symptoms of rotator cuff tears

The most common symptoms of a tear are:

• Pain when you move your arm, especially when you move it over your head or against resistance.
• Pain at night.
• Weakness in your shoulder. But some people don't notice any weakness if the tear is small.

Symptoms of a sudden, severe tear include:

• A popping sound or feeling like something is tearing in your shoulder.
• Sudden pain in your shoulder.
• Weakness and pain when you lift or rotate your arm.
• Limited range of motion and not being able to raise your arm because of pain or weakness.
• Swelling or a bump at the site of the tear.
• In some cases, bruising in your shoulder or upper arm.

You can have a complete tear without symptoms, especially if you are an older adult who is not very active.

How is it diagnosed?

To diagnose a rotator cuff disorder, doctors ask about any shoulder injuries or past shoulder pain. They also do a physical exam. The exam helps them to see how well the shoulder works and to find painful areas or activities. Moving your arm in certain ways can help the doctor learn about the condition of the rotator cuff.

You may have an X-ray to check the bones of the shoulder. If the diagnosis is still unclear, the doctor may order more tests. This may include an imaging test, such as an MRI, an ultrasound, or sometimes an arthrogram.

Your doctor thinks about your age, job, and activity level when deciding about more tests. A clear diagnosis is important if you are likely to keep doing things that may do more damage to your shoulder.

How are rotator cuff disorders treated?

Treatment depends on your symptoms, your age, and how active you are. Your treatment may include:

• Medicines. Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are often used for pain and inflammation. If other treatments don't help, your doctor may give you a shot of steroid medicine in the shoulder.
• Home treatment, such as rest and applying cold or heat.
• Physical therapy to stretch and strengthen the shoulder.

Most rotator cuff disorders aren't treated with surgery. But doctors may do surgery if a rotator cuff tendon is torn. They may also do it if several months of other treatments haven't helped. Whether or not you get surgery will depend on your age, the amount of other damage in the shoulder, and the chances that surgery will be a success in your case. And surgery is not a substitute for physical therapy. Even after surgery, you may need months of physical therapy to recover fully.

How can you prevent it?

The long-term changes to the shoulder joint from everyday wear and tear can't be totally prevented. But you may be able to prevent some rotator cuff problems if you:

• Keep the muscles in your shoulders flexible and strong. Daily exercises may be the best way to do this and help prevent a rotator cuff disorder.
• Have good posture. Stand straight and relaxed, and don't slump.
• Don't lift objects that are too heavy for you, especially over your head.
• Avoid sports or other activities where forceful contact or falls are likely or common.
• Don't keep your arms out to the side or raised over your head for long periods of time. If you must do these activities:
  • Take breaks often. Ice your shoulder several times a day and at night.
  • Take a nonsteroidal anti-inflammatory drug (NSAID) to relieve any swelling and pain in the tissues that are being pinched.