IMPINGEMENT SYNDROME AND ROTATOR CUFF TEARS
The rotator cuff is represented by a group of tendons that surround the shoulder joint and are fused together. The muscles of those tendons originate from the scapular bone. The tendons themselves are attached to the humeral bone. The main function of the rotator cuff tendons and muscles is to rotate the shoulder joint inward, upward or outward.
During the shoulder movements the uppermost part of the rotator cuff tendons have to pass beneath the acromial bone (the bone on the top of the shoulder). The space between the acromial bone and humeral head is quite narrow. To protect the tendon from excessive rubbing a bursa is developed between the acromion and the rotator cuff. There is a chance the rotator cuff tendon may be pinched especially when the shoulder is unstable or overused. That usually happens when the arm is raised in forward position. The rotator cuff and bursa can became inflamed and swollen. This results in pain and restriction af movements.
Impingement of the rotator cuff leads to excessive rubbing of the tendons against the acromial bone. The tendon begins to break down near its attachment. The process can cause a complete tear of the tendon from the bone.
The difference in the shoulder joint anatomy and the tendon tissue microstructure cause some people to develop impingement syndrome more than others. The form and dimensions of the acromial bone plays an important role. Some acromia have a spur originated at the front edge that may cause impingement in forward elevation of the arm. Overuse of the shoulder join related to some sport or occupational activities leads to impingement as well. Instability of the shoulder, which causes it to move forward with certain activities, is one of the reasons for developing a rotator cuff injury.
The most common complaint is aching located in the top and front of the shoulder, or on the outer side of the upper arm (deltoid area). The pain is usually increased when the arm is lifted to the overhead position. Frequently, the pain seems to be worse at night, and often interrupts sleep. Depending on the severity of the injury, there may also be weakness in the arm and, with some complete rotator cuff tears, the arm cannot be lifted in the forward or outward direction at all.
The diagnosis of rotator cuff tendon disease includes a careful history taken and reviewed by the physician, an x-ray to visualize the anatomy of the bones of the shoulder, specifically looking for acromial spur, and a physical examination. Atrophy may be present, along with weakness, if the rotator cuff tendons are injured, and special impingement tests can suggest that impingement syndrome is involved. A MRI (magnetic resonance imaging) scan frequently gives the final diagnosis.
Treatment of the impingement syndrome starts with rehabilitation and anti-inflammatory drugs. Gradual strengthening of the weak rotator cuff muscles using special exercises has proved beneficial on an impinged rotator cuff.
If conservative treatment has failed to achieve improvement within 6 months since the initiation of the symptoms, surgery has to be considered. The main goals of the operation are to enlarge the narrow space between acromial bone and humeral head and to repair torn rotator cuff. The former is achieved by cutting out part of the undersurface of acromion using a technique named acromioplasty. The bone anchors recently invented in shoulder surgery make possible to repair the tendon directly to bone. Actually repairing is the most controversial part of the rotator cuff surgery. As usual torn rotator cuffs are pretty much "worn out" because of the damage caused by impingement. Tissue quality is not good. The surgeon should be very meticulous and experienced in the field of shoulder surgery to fix the tear in a best possible way. Sometimes tissue quality is so bad that it is impossible to repair the cuff properly. These patients are still very satisfied with acromioplasty and "cleaning" of the joint (cutting out the dead and damaged tissues and removing inflamed and thickened bursa). Check out one of our techniques for Impingement Syndrome treatment and Rotator Cuff repair.
The answer to this question depends on your general health condition and your lifestyle. If your shoulder pain restricts your usual activities, if the drugs and physical therapy dont work for you, you may be a good candidate for surgery. For any questions about your shoulder don't hesitate to contact us.
The information provided here is not meant to take the place of the complete exam by a physician. If you have an injury we strongly encourage you to get adequate medical care