Rotator Cuff Impingement: Causes, Symptoms, and Treatment

What is Rotator Cuff Impingement?

Rotator cuff impingement happens when the tendons or bursa of the rotator cuff muscles are pinched by the acromion (the top part of the shoulder blade) and the humeral head (the top of the upper arm bone). This compression can lead to inflammation and damage to the rotator cuff tendons over time. The condition typically causes pain, especially when lifting the arm or performing overhead motions.

Causes of Rotator Cuff Impingement

Several factors contribute to rotator cuff impingement, including:

• Repetitive Overhead Activities: Activities such as swimming, throwing, or lifting weights can stress the rotator cuff tendons, causing them to rub against the acromion and leading to impingement.

• Aging and Degeneration: As we age, the rotator cuff tendons become less flexible and weaker, increasing the risk of impingement. The acromion may also change shape or develop bone spurs, further narrowing the space for the tendons.

• Poor Posture: Rounded shoulders or forward head posture can change the alignment of the shoulder joint, leading to compression of the tendons in certain positions.

• Shoulder Trauma: A fall or injury that affects the shoulder can cause changes in the alignment of the bones, leading to impingement.

• Shoulder Abnormalities: Structural issues, such as a hooked acromion or a thickened ligament, can decrease the space available for the rotator cuff tendons and increase the risk of impingement.

Symptoms of Rotator Cuff Impingement

Common symptoms of rotator cuff impingement include:

• Shoulder Pain: Pain is often felt at the front or side of the shoulder and may worsen with overhead movements or reaching behind the back. The pain can be sharp or aching and often occurs when lifting the arm or performing repetitive tasks.

• Weakness: There may be weakness in the shoulder, especially when lifting or reaching. Tasks that require arm elevation, such as combing hair or lifting objects, may become more difficult.

• Limited Range of Motion: It may become hard to raise the arm fully or perform activities that involve overhead motion, such as reaching up or lifting.

• Night Pain: Many people experience pain at night, particularly when lying on the affected shoulder. This can disrupt sleep.

• Shoulder Stiffness: Reduced flexibility and tightness in the shoulder may develop as a result of the impingement.

Diagnosing Rotator Cuff Impingement

Diagnosis is based on a combination of medical history, physical examination, and imaging tests:

• Physical Examination: A healthcare provider will perform specific tests, such as the Neer test or Hawkins-Kennedy test, which are designed to reproduce symptoms of impingement and assess the range of motion, strength, and tenderness of the shoulder.

• X-rays: X-rays can help detect bone spurs or abnormalities in the acromion or other shoulder structures. While X-rays can't directly visualize soft tissue damage, they can provide valuable information about structural changes.

• MRI or Ultrasound: An MRI or ultrasound can provide detailed images of the soft tissues, allowing doctors to see if there is any inflammation, swelling, or rotator cuff tendon damage. These tests are the most accurate for diagnosing rotator cuff injuries.

• Arthroscopy: In rare cases, an arthroscopic examination may be performed to directly view the shoulder joint and evaluate the extent of the impingement and any associated damage to the tendons.

Treatment for Rotator Cuff Impingement

Most cases of rotator cuff impingement can be managed conservatively through non-surgical treatments, although surgery may be required for more severe cases. Treatment options include:

Non-Surgical Treatment

• Rest and Activity Modification: Resting the shoulder and avoiding overhead activities or movements that cause pain is essential to allow inflammation to subside.

• Physical Therapy: A physical therapist will guide you through strengthening exercises to improve the rotator cuff and scapular muscles, improve posture, and restore shoulder function. Stretching exercises may also help relieve tightness and improve flexibility.

• Anti-Inflammatory Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help reduce pain and inflammation in the shoulder.

• Corticosteroid Injections: In some cases, a corticosteroid injection may be used to reduce inflammation and pain. However, repeated injections can weaken the tendon, so they are used cautiously.

• Ice Therapy: Applying ice to the shoulder can help reduce swelling and pain, especially after physical activity or exercise.

• Shoulder Bracing: A brace or sling may be used to immobilize the shoulder and reduce movement, providing relief from symptoms.

Surgical Treatment

If non-surgical treatments do not alleviate symptoms, surgery may be necessary to relieve the impingement. Surgical options include:

• Subacromial Decompression: This procedure involves removing or shaving down the acromion (the bony structure above the shoulder joint) to increase the space available for the rotator cuff tendons. This can reduce compression and alleviate symptoms of impingement.

• Rotator Cuff Repair: If the tendons are damaged or torn as a result of the impingement, a surgical repair may be performed to reattach the tendons to the bone.

• Acromioplasty: This is a procedure to remove bone spurs or other structures causing impingement by reshaping the acromion to reduce pressure on the rotator cuff.

Post-Surgery Rehabilitation

Recovery from surgery typically involves a period of rest followed by a rehabilitation program. The rehabilitation program may include:

• Physical Therapy: After surgery, a structured rehabilitation program is essential to restore strength, flexibility, and range of motion to the shoulder.

• Gradual Return to Activity: Patients should avoid strenuous activities and overhead motions until fully recovered, which may take several months.

Recovery and Prognosis

• Healing Time: Recovery time for rotator cuff impingement varies depending on the severity of the condition and whether surgery is required. Non-surgical treatment may take 6-8 weeks, while surgery can take 3-6 months for full recovery.

• Long-Term Outlook: With proper treatment, most people experience significant improvement in shoulder function and a reduction in pain. Surgery, when required, is often successful in alleviating symptoms and preventing further injury, although full recovery can take time.

Preventing Rotator Cuff Impingement

While some factors, such as aging, are unavoidable, there are several strategies to reduce the risk of developing rotator cuff impingement:

• Strengthening Exercises: Regularly strengthening the rotator cuff muscles can help improve shoulder stability and prevent impingement. Exercises should focus on the rotator cuff, deltoid, and scapular muscles.

• Postural Awareness: Maintaining proper posture during daily activities and exercise helps keep the shoulder joint in proper alignment and reduces stress on the rotator cuff tendons.

• Warm-Up Before Activity: A proper warm-up before engaging in physical activity helps prepare the muscles and tendons for the demands of exercise and reduces the risk of injury.

• Avoid Overuse: Repetitive overhead motions should be limited or modified to prevent excessive strain on the shoulder. If you participate in overhead sports or activities, be mindful of rest and recovery time.

Expert Care at Palms Physiotherapy & Allied Health

At Palms Physiotherapy & Allied Health, our experienced physiotherapists provide personalized care for individuals with rotator cuff impingement. Whether you're dealing with pain, weakness, or limited shoulder mobility, we can help develop a treatment plan tailored to your needs, utilising physical therapy, strengthening exercises, and other therapies.