IMPINGEMENT (TENDONITIS, BURSITIS), AC ARTHRITIS

Cause

The most common causes of pain in the adult shoulder result from shoulder impingement syndrome. This occurs when the long roof of the shoulder puts pressure on the rotator cuff tendons as the arm is lifted. The rotator cuff travels through a narrow arch, which can rub or impinge on the surface of these tendons. The pain may be due to an inflammation and swelling of the tendons and bursa that overlies the rotator cuff. In some circumstances, a partial tear of the rotator cuff may cause impingement pain. Arthritic change of the AC joint may also contribute.

Prevention

Both young athletes and middle-aged people experience impingement. Young athletes who use their arms overhead for swimming, baseball and tennis are particularly vulnerable. Those who do repetitive lifting or overhead activities using the arm such as paper hanging, construction or painting are also susceptible. Pain may also develop as the result of minor trauma or spontaneously with no apparent cause.

Treatment

Resting, avoiding overhead activities, and a course of oral non-steroidal anti-inflammatory medication are often the first steps. Stretching exercises can improve range of motion. An injection of local anesthetic and a cortisone preparation to the affected area may help. An orthopedist might also recommend a program of supervised physical therapy. Treatment may take several weeks to months. Many patients experience a gradual improvement and return to function.

If function does not improve, surgery may be indicated. Surgery will remove the impinging structures, creating more space for the rotator cuff. The most common surgical treatment is subacromial decompression. Calcium deposits can be removed when necessary. Resection of the arthritis from the AC joint and treatment of an inflammed biceps may also be necessary. Usually these procedures are done arthroscopically or through a miniopen approach.