Submitted by McLean County Orthopedics
The most movable joint in the body, the shoulder is also one of the most potentially unstable joints. As a result, it is the site of many common problems that cause pain. Damage to the rotator cuff is one of the most common disorders of the shoulder leading to not only pain, but disability and degeneration. The rotator cuff is a group of four tendons that work together to stabilize the shoulder joint. Each tendon is attached to a muscle that moves the shoulder in a specific direction. If you think about how many different ways the shoulder moves, you can easily see the importance of a healthy rotator cuff.
Rotator cuff disease: tendinitis and bursitis
These conditions are closely related and may occur alone or in combination.
Tendinitis is inflammation (redness, soreness, and swelling) of a tendon. In tendinitis of the shoulder, the rotator cuff or biceps tendon become inflamed, usually as a result of being pinched by surrounding structures. The injury may vary from mild inflammation to involvement of most of the rotator cuff. When the rotator cuff tendon becomes inflamed and thickened, it may get trapped under the outward end of the shoulder blade (acromion). Squeezing of the rotator cuff is called impingement syndrome.
Bursitis, or inflammation of the bursa sacs that protect the shoulder, may accompany tendinitis and impingement syndrome. Inflammation caused by a disease such as rheumatoid arthritis may cause rotator cuff tendinitis and bursitis. Sports involving overuse of the shoulder and occupations requiring frequent overhead reaching are other potential causes of irritation to the rotator cuff or bursa and may lead to inflammation and impingement.
If the rotator cuff and bursa are irritated, inflamed, and swollen, they may become squeezed between the head of the humerus and the acromion. Repeated motion involving the arms, or the effects of the aging process on shoulder movement over many years, may also irritate and wear down the tendons, muscles, and surrounding structures.
- Symptoms. Signs of these conditions include the slow onset of discomfort and pain in the upper shoulder or upper third of the arm or difficulty sleeping on the shoulder. Tendinitis and bursitis also cause pain when the arm is lifted away from the body or overhead. If tendinitis involves the biceps tendon (the tendon located in front of the shoulder that helps bend the elbow and turn the forearm), pain will occur in the front or side of the shoulder and may travel down to the elbow and forearm. Pain may also occur when the arm is forcefully pushed upward overhead.
- Diagnosis. Diagnosis of tendinitis and bursitis begins with a medical history and physical examination. X-rays do not show tendons or the bursae, but may be helpful in ruling out bony abnormalities or arthritis. Your doctor may remove and test fluid from the inflamed area to rule out infection. Impingement syndrome may be confirmed when injection of a small amount of anesthetic (lidocaine hydrochloride) into the space under the acromion relieves pain.
- Treatment. The first step in treating these conditions is to reduce pain and inflammation with rest, ice, and anti-inflammatory medicines such as aspirin and ibuprofen. In some cases, your doctor or therapist will use ultrasound to warm deep tissues and improve blood flow. Gentle stretching and strengthening exercises are added gradually. These may be preceded or followed by use of an ice pack. If there is no improvement, the doctor may inject a corticosteroid medicine into the space under the acromion. Although steroid injections are a common treatment, they must be used with caution because they may lead to tendon rupture. If there is still no improvement after six to 12 months, surgery may be recommended to repair damage and relieve pressure on the tendons and bursae.
Next month’s article will discuss rotator cuff tears. If you missed the previous articles about shoulder pain, you may read them online at HealthyCellsBN.com or call 309-664-2524.
For more information on any orthopedic problem, call 309-663-6461 to schedule an appointment with the board-certified physicians at McLean County Orthopedics or visit their website at www.mcleancountyorthopedics.com. Their new office is located at 1111 Trinity Lane in Bloomington.