Rotator cuff tendonitis (shoulder impingement)

Rotator cuff tendonitis or shoulder impingement is a frequent cause of shoulder pain. It is sometimes known as ‘subacromial impingement’ and there are three main reasons why it happens:

  • Tendonitis: where the tendon becomes damaged or irritated
  • Bursitis: where the bursa (a fluid filled sac) becomes swollen and inflamed
  • Impingement: where the space between the acromion and rotator cuff is narrowed, causing the acromion (the end of the shoulder blade) to rub (or impinge) on the tendon when the arm is raised to shoulder height

How is it caused?

This type of tendonitis is usually caused by overuse of the rotator cuff, and is common in younger athletes who take part in overhead activities such as tennis or swimming.

What are the symptoms?

Symptoms may be mild at first and include pain when carrying out overhead movements such as throwing and, in some cases, while resting. If untreated, symptoms usually become worse and can cause loss of strength, limited movement, and pain during the night.

How is it diagnosed?

Having discussed your symptoms, the specialist will look for signs of other problems such as a pinched nerve or osteoarthritis, while checking for signs of tenderness or deformity, as well as your range of movement and arm strength. You may have an X-ray to check for other problems including bone spurs or osteophytes (bony lumps around the joints) which develop with age as well as an MRI or ultrasound scan to show the extent of damage to the rotator cuff.

How is it treated?

Non-operative treatment: this includes rest, taking anti-inflammatory medication, if advised by your specialist and a gentle programme of stretching exercises to help improve your range of movement and strengthen the rotator cuff muscles. You may also be offered a steroid injection into the bursa below the acromion to reduce pain and inflammation.

Surgery: if your symptoms don’t improve you may be offered surgery to allow more space around the rotator cuff by removing the inflamed part of the bursa and/or removing part of the acromion. This procedure is called subacromial decompression and is usually carried out using arthroscopy.

How long does it take to recover from surgery?

You will probably need to wear a sling for a week or two, after which you will be given some gentle exercises to improve your strength and range of shoulder movement. It can take between two and four months for symptoms to improve and up to a year for a full recovery.

Important: This information is only a guideline to help you understand your treatment and what to expect. Everyone is different and your rehabilitation may be quicker or slower than other people’s. Please contact us for advice if you’re worried about any aspect of your health or recovery.

Arthroscopy allows surgeons to use a type of keyhole surgery to diagnose and treat joint problems.
Shoulder replacement surgery is not as common as knee or hip replacement, but can be very effective in relieving joint pain and helping people to carry on with everyday activities.
Used for treating calcific tendonitis of the rotator cuff, this outpatient procedure uses ultrasound technology

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