What is Rotator Cuff Tendonitis / Bursitis (Impingement Syndrome)?

Rotator cuff tendons are four small tendons around the shoulder, which are crucial in normal movement and function of the shoulder. Two of these tendons glide underneath a rigid bony and ligamentous arch. A bursa is located between the tendon and this arch to reduce the friction between the two.

Some people are born with a "hooked" acromion that will predispose them to this problem. Others have rotator cuff weakness that causes the humerus to ride up and pinch the cuff. This means that the bursa — a water-balloon type structure that acts as a cushion between the rotator cuff and acromion/humerus — gets inflamed.

What Are The Causes of Rotator Cuff Tendonitis/Bursitis?

For various reasons one may develop inflammation and pain in the area of these tendons and bursa.

This could happen because of abnormal bony anatomy and existence of a bone spur, which increases the friction between the tendon and bone.

It may also happen because of a muscular and postural imbalance that makes it more likely for the tendons to rub against the bone. This also could happen as the result of the natural aging process or trauma.

What Are The Symptoms of Rotator Cuff Tendonitis/Bursitis?

The pain can get so significant as to interfere with light or moderate lifting. Daily activities such putting on a jacket, washing one’s head or reaching behind the back can be quite painful. Night symptoms are common and can preclude the patient from sleeping on the affected side.

Some common symptoms:

• Pain
• Popping
• Weakness
• Inability to sleep on shoulder

Who Is Likely To Develop This Condition?

It most commonly affects individuals 40 years of age or older. People who engage in repetitive overhead activities are at increased risk for developing this condition.

If the patient complains of pain in the shoulder radiating down to the arm or if there is worsening of the pain with the arm in the overhead position, bursitis is likely.

The condition is diagnosed by obtaining a detailed history and doing a proper physical examination. X-rays are obtained routinely. MRI may also be obtained to assess the degree of damage to the tendons.

What Is The Treatment for Rotator Cuff Tendonitis/Bursitis?

In the early stages of the condition, the patient is advised to stop all aggravating activities; he is referred to physical therapy and given anti-inflammatory medications. In moderate to severe cases, or if the above measures fail, the patient is given a cortisone injection to reduce the inflammation.

In case all these measures fail, and the patient continues to be symptomatic, surgery will be discussed with the patient. Arthroscopic surgery can remove bone spurs and inflamed tissue around the shoulder in an outpatient procedure.

During the arthroscopic surgery, the bursa is shaved and the bone spur is removed to provide for more room for the tendons to glide underneath the arch.

Since the procedure is arthroscopic, it is performed through 3-4 small incisions using a fiber-optic camera, highly specialized shavers and other instruments.

Sutures are removed in 5-7 days and physical therapy is started shortly after that. The patient has no specific restrictions and may gradually increase his activities as tolerated.

Will I Have Pain?

Without proper treatment the condition may progress, resulting in a partial or complete tendon tear. The surgery for a tendon tear is more difficult. If the tendon has been torn for a long period of time, it might not be repairable.

Sutures are removed in 5-7 days and physical therapy is started shortly after that. The patient has no specific restrictions and may gradually increase his activities as tolerated.

The injured shoulder should be rested from the activities that caused the problem and from activities that cause pain. Ice packs applied to the shoulder and non-steroidal anti-inflammatory drugs will help reduce inflammation and pain.

Physical therapy to strengthen the muscles of the rotator cuff should be started. If the pain persists or if therapy is not possible because of severe pain, a steroid injection may reduce pain and inflammation enough to allow effective therapy.

When Can I Go Back To Work or School?

A person is usually able to return to work within several days, unless his or her job requires heavy lifting. Most people recover full function after a combination of medications, physical therapy and steroid injections. For patients with tendonitis and a bone spur, arthroscopic surgery is usually successful in restoring them to their pre-injury level of activity.

Will Insurance Cover It?

Most insurance companies offer reimbursement for reconstructive procedures. If you are having surgery to correct an abnormality, insurance coverage can likely be obtained. Pre-authorization by the insurance company is required prior to surgery.

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