- In a normal pain-free shoulder, there's enough room
under your acromion for your rotator cuff tendons
to slide when you move your arm.
The tendons may pinch slightly,
but this doesn't typically lead to pain.
The more overhead activity you do, the worse your pain gets.
The factors contributing to an impingement syndrome are
repetitive overhead use.
A hook on the end of your acromion.
The larger your hook, the higher the likelihood
of developing impingement.
Also bone spurs on the end of your acromion
can cause impingement.
Well all three of these problems reduce the amount of space
between the acromion and the humerus, causing impingement.
Let's take a look at the symptoms of
rotator cuff impingement and tendonitis,
and how they affect your daily life.
- The two main symptoms of rotator cuff impingement
are pain and stiffness.
These symptoms develop over time,
depending on your age and activity level.
The first symptom you'll develop is a nagging,
persistent shoulder pain.
That pain is often made worse when you
use your arm above the shoulder level.
Once you have pain, you'll start to limit
the use of the arm to avoid feeling the pain.
This is what causes the stiffness in your shoulder.
The movements that cause you the most pain vary,
but are generally ones that require you to
reach above the shoulder level or reach behind your back.
These movements can be broken down into several categories.
The first is simple activity, such as reaching up
into a cabinet, reaching into your back pocket
for your wallet, or getting dressed can cause you pain.
The second is work activities.
Your job requirements can make your pain worse
on a daily basis, especially if your job requires
any repetitive overhead lifting, pushing or pulling.
The third is sports activities.
Sports movements like repetitive overhead throwing
or swimming can aggravate your symptoms.
The last category is sleeping.
Lying on a painful shoulder can cause you pain
and wake you from sleep.
Most people only seek treatment once their shoulder pain
is bad enough or when the symptoms interfere
with their daily lives.
When I evaluate my patients for rotator cuff impingement,
I wanna know how long you've had the pain,
and how the pain interferes with your normal activities.
In addition to the history of your symptoms,
I also perform a physical exam to look for
several specific findings.
First is the location of your pain,
which is often on the side of your arm and into your neck.
Next I'll check to see if your shoulder is stiff or stuck
be evaluating your range of motion.
And finally, I'll evaluate your shoulder
for any weakness by testing the strength
of the muscles in your shoulder.
- Let's talk about what I call the shoulder pain cycle.
When you have pain in your shoulder
as a result of impingement and inflammation,
you avoid using your shoulder.
As you avoid using your shoulder,
that is you favor your shoulder,
the shoulder scars down or gets stuck in the back.
When this happens, the pain increases even more.
Well again, as the pain increases even more,
you avoid using it even more.
We get into a pain cycle, an increasing pain cycle,
a cycle that we have to break with treatment.
Breaking it with treatment means getting unstuck.
Getting unstuck means getting yourself
in the hands of a physical therapist.
This is a x-ray of a patient with shoulder pain.
Let's look at the parts list.
This is the middle of the ball.
This is the surface of the ball.
This is the arm that is connected to the ball.
The ball sits in the socket
which is at the end of the shoulder blade.
This is the shoulder blade.
Above the ball sit these two bones,
the acromion bone and the clavicle or collar bone.
And then in this space
between the acromion bone and the top of the ball
sits the rotator cuff tendon.
This is the rotator cuff tendon,
and it pulls in this direction.
This patient has a bone spur that's pinching
on the rotator cuff tendon.
This bone spur is the source of pain and impingement
in this patient.
This an MRI of this same patient with shoulder pain.
Once again, let's look at the parts list.
This is the middle of the ball.
This is the surface of the ball connected to the arm.
And up above we have the acromion bone.
Sitting between the acromion bone and the top of the ball
is this black structure.
This black structure is the rotator cuff tendon.
This rotator cuff tendon is being pinched
by this bone spur
causing pain and impingement.