Shoulder Conditions and Treatments

Rotator Cuff Tendinitis, Shoulder Bursitis, Impingement Syndrome

These terms all refer to the same shoulder problem that is the most common cause of pain around the shoulder. Though the causes are many, the final common pathway of the disease is a superior migration of the humeral head within the glenoid (shoulder socket). As this occurs one or more of the rotator cuff tendons is pinched (hence the term impingement syndrome). If this happens repetitively the tendon(s) become inflamed, irritated, and swollen (hence the term rotator cuff tendinitis). The space where the pinching occurs also contains the subacromial bursa that may become inflamed and thickened (hence the term shoulder bursitis).

Causes

The most common cause of this shoulder problem is weakness of the rotator cuff muscles. The rotator cuff's primary function is to hold the ball of the shoulder in the socket when someone is active. If the muscles become weak or are injured, the humeral head (shoulder ball) will be allowed to migrate superiorly. The problem is perhaps the best-known overuse injury and individuals who work overhead (carpenters, plumbers) or overhead athletes are prone to this problem. Other problems which result in rotator cuff weakness (partial or full thickness tears and muscle atrophy secondary to disuse) often have a component of tendinitis.

Though logical, the presence of shoulder bone spurs does not necessarily lead to rotator cuff tendinitis. Hence, the presence of a bone spur does not mean an individual will get tendinitis. However, when a patient does have tendinitis, a bone spur is usually present.

Symptoms

• Aching pain
• Trouble sleeping
• Pain worsened by overhead activity
• Weakness (secondary to pain)
• Clicking or popping

Treatment

Non-operative
Fortunately, the majority of individuals with this problem get better with time and exercises. Avoiding activities which aggravate the shoulder as well as beginning a rotator cuff strengthening program are the initial steps in recovering. Anti-inflammatories can help reduce the discomfort to allow these exercises to be done. Cortisone injections are occasionally needed to reduce pain and allow better ability to perform the exercises. Emphasis during the rehabilitation is on the shoulder blade muscles (peri-scapular) as these muscles, when strong, form a strong foundation for the rotator cuff muscles to work with. Normally a period of at least eight to 12 weeks is attempted before conservative therapy is felt to have failed.

Alternative Treatment Options

• Glucosamine
• Hyaluronic Acid
• Non-steroidal Anti-inflammatory Medications (NSAIDs)

Operative
In more severe cases, when rehabilitation is not successful, surgery may be suggested. This occurs in roughly 10 to 15 percent of cases. The surgery is directed at removing inflamed tissue and bone spurs if they exist (subacromial decompression). Secondary problems such as partial thickness rotator cuff tears and A/C joint arthrosis are commonly encountered and can be dealt with at the same time.