• Diagnosis
  • Treatment
  • Rehabilitation

Rotator Cuff Impingment

Also known as: Impingement syndrome, Supraspinatus tendinitis, Subacromial bursitis, Rotator Cuff disease, Painful Arc syndrome

The rotator cuff is a group of tendons that connects the shoulder muscles to the bones in the arm and shoulder. These tendons enable the muscles to lift and rotate the arm.

Rotator cuff impingement occurs when the tendon becomes trapped in the acromion space below the shoulder blade (scapula) and is repeatedly scraped against the bone. The syndrome can be brought on by gradual minor injuries, sustained through repetitive overhead work or activity, an isolated injury or develop spontaneously. It can occur in any age group, but is most common among people in their fifties.

Symptoms

The shoulder feels weak and painful particularly when the arm is raised or reaching behind the back. The pain often radiates into the upper arm muscles and sometimes patients will experience a sharp catching or aching after use. Pain at night when lying on the affected side is also common.

Investigation

These include x-ray, ultrasound scan and possibly an MRI scan. These are designed to exclude arthritis and identify tears of the rotator cuff tendons.

Rotator Cuff Impingment

Appropriate and early non-operative treatment is often successful and should be attempted in most cases. This includes:

Physiotherapy aimed at strengthening the rotator cuff muscles, together with simple anti-inflammatories (e.g. Ibuprofen) and painkillers (e.g. Paracetamol)

Steroid (cortisone) injection combined with physiotherapy, which reduces inflammation and strengthens the muscles.

Surgery

Decompression operation – otherwise known as Arthroscopic subacromial decompression (ASAD) – is a keyhole procedure which creates more room for the rotator cuff tendon to move. It is normally performed under a general anaesthetic and has a good to excellent outcome.

Rotator Cuff Impingment

Non-Surgical management: This condition can be managed effectively by physiotherapy which is aimed at improving the shoulder blade (scapula) position to increase the room in the sub-acromial space available for the rotator cuff tendons to move. Therefore the tendons are not pinched or scraped by the bone in the space and can function again without pain.

Physiotherapy mainly involves soft tissue mobilisation by means of manual therapy (hands on stretches) by an expert physiotherapist as well as postural exercises to stabilise the scapula in a better position. Sometimes acupuncture, taping and stretches are used to assist this re-positioning of the scapula.

Post-operative management: The main aim is to restore a good sub-acromial space to allow the operated tendon to recover fully. Postural and gentle mobilising exercises will be used in the early stages to assist improving the movement in the shoulder. Once the tendon is healed then more advanced exercises and stretches will be used to regain full strength and movement while maintaining a good shoulder posture.

All rehabilitation techniques will be tailored to each individual client and their lifestyle so that the shoulder maintains a good position in all activities that each client does from work to leisure.