Shoulder Impingement

The Shoulder consists of a Ball that fits into a Socket.
The rotator cuff is a group of tendons that insert into the ball of the shoulder thereby stabilizing it within the socket. One or more of the tendons in the rotator cuff may be torn either by :

  • A fall or jerk
  • The constant irritation of repetitive overhead arm motions
  • Degenerative damage, due to wear and tear, as we age

In many instances, the reason for the rotator cuff injury is unknown


IMPINGEMENT SYNDROME A torn rotator cuff will cause pain at the top and outside of the shoulder especially when you raise or extend your arm. Sleeping on the affected side might be uncomfortable. The shoulder may become weak, making it difficult to raise the arm far away from the side.

Depending on the size of the tear, arthroscopic surgery can be used to reattach the torn edge of the rotator tendon to the ball (humerus). Large and complex tears are usually repaired by mini open techniques, or through a combination of open and arthroscopic procedures.

Patients spend a day in the hospital. They use a shoulder sling for approximately 3 weeks wherein they are suggested some exercises to keep the shoulder mobile. After 3 weeks an active rehabilitation regime is followed involving mobilization and strengthening. Movement returns in approximately 6 weeks and strength in approximately 4-5 months. Patients report dramatic pain relief such that they can sleep well and perform activities of daily living without discomfort.

The Rotator Cuff tendons traverse the shoulder above the ball and beneath the top of the shoulder blade (the Acromion). There is normally a small pad of tissue that acts as a cushion between the acromion and the rotator cuff, allowing the smooth gliding movements of the rotator cuff tendon known as the Subacromial Bursa.

Rotator Cuff Tear Repetitive motion - or the normal wear and tear of aging - may cause irritation of :
The tendons of the rotator cuff against the undersurface of the acromion (tendinitis).
The subacromial bursa (bursitis).

Impingement syndrome is the first stage of potential rotator cuff problems. It is called impingement syndrome because the rotator cuff tendons are "impinged" - that is, squeezed between the moving ball and the acromion. This results in inflammation and swelling of the rotator cuff tendons.

Tendinitis and bursitis cause slowly increasing discomfort and pain in the upper shoulder or the upper third of the arm. Sleeping on the shoulder may be painful, and there may be pain when raising the arm away from the body or overhead.

In many cases, tendinitis and bursitis can be improved with rest, ice, and anti-inflammatory drugs such Brufen, in combination with physical therapy or with the use of a steroid injection.

If the condition does not respond to these conservative measures, arthroscopic surgery may be used to increase the space for the rotator cuff tendons, to allow them to glide freely, by removing some of the undersurface of the acromion bone and clearing the inflamed bursal tissue. The biceps tendon, which passes through the shoulder joint, may also become inflamed.

This is known as 'biceps tendinitis.' Machine Based Physiotherapy, Injections or in resistant cases, Arthroscopic Surgery can significantly help.