A Rotator Cuff Injury
A rotator cuff injury is diagnosed first with a physical exam where a doctor will move your arm in different directions to assess your pain levels and range of motion.

After examining you and taking your detailed history, your orthopedic doctor may suggest the following treatments considering your age, activity level, and general health:

  • Rest: Avoiding overhead or rigorous activities with your injured arm is the best way to heal the swelling. It will lessen the stress on your shoulder which is causing pain.
  • Applying ice: Applying ice may help you to soothe your pain and swelling around the shoulder. Apply cold intermittently within the first 48 hours of pain and injury to your shoulder.
  • Applying heat: Applying heat by hot packs may relieve your pain for some time by increasing the blood flow toward your shoulder.
  • Pain relievers: Medications such as paracetamol, diclofenac, Tylenol (ibuprofen), and naproxen may reduce your shoulder pain and swelling. You may receive it in a tablet form taken by mouth or in some cream, gel, or spray form. Your doctor may prescribe these to heal your shoulder pain completely. Do not take it without advice from your doctor. Prolonged intake of these medicines may give you stomach ulcers and internal bleeding.
  • Physical therapy: Physical therapy may restore your shoulder motion to normal sooner. Specific stretching exercises may help you to relieve your shoulder pain. After your shoulder pain improves, your therapist may advise you on some strengthening exercises for your rotator cuff muscles. Daily stretching exercises with a warm shower may help to reduce the pain and discomfort.
  • Steroid injection: If you do not get any relief from rest, pain relievers, and physical therapy, then your doctor may inject a combination of a local anesthetic solution and steroid directly into your joint. It is only used by your doctor when necessary. Repeated use of this injection may weaken your muscle and tendon. 
  • Manual therapy: These are specific hands-on techniques including manipulation and mobilization of the joints that are administered by some physiotherapists, chiropractors, and osteopaths.
  • Electrophysical agents: Some electrophysical agents such as transcutaneous electromagnetic stimulation (TENS), bipolar interferential current, pulsed electromagnetic field therapy (PEMF), low-level laser therapy (LLLT), and therapeutic ultrasound are rarely used in combination with exercises and other treatments.

Shoulder impingement commonly requires three to six months to heal completely. If you have severe shoulder impingement, it may take a year to heal. However, you can start your normal activities within two to four weeks. Generally, shoulder problems can be treated conservatively. However, in severe cases, you may require surgery.

What does shoulder impingement mean?

Your shoulder is made up of several joints, tendons (flexible inelastic cord), and muscles that provide a great range of motion to your arm. This group of muscles and tendons is called the rotator cuff.

Sometimes, you may get pain when you raise your arm above your shoulders. The tendons in your shoulder socket may get pinched as it passes between the top of the upper arm bone (humerus) and the tip of your shoulder (acromion) known as shoulder impingement. It is commonly seen in elders and athletes because of a shoulder injury.

You may have a shoulder injury of the following severity:

  • Grade 1: Swelling, redness, and pain in the shoulder
  • Grade 2: Progressive thickening of the area with reduced mobility
  • Grade 3: Tears in the rotator cuff or changes in the shoulder bone due to bony growth (severe)

What are the causes of shoulder impingement?

Causes include:
  • Injury
  • Age above 50 years
  • Tear and wear of your shoulder muscles
  • Weak tendons and muscles
  • Heavy weight-lifting or overhead activities such as hanging, construction, or wall painting
  • Rigorous sports such as swimming, baseball, and tennis
  • Unknown cause

QUESTION

Medically speaking, the term "myalgia" refers to what type of pain? See Answer

What are the surgical treatments for shoulder impingement?

If your symptoms persist even after all medications, then your doctor may order an ultrasound, magnetic resonance imaging (MRI), and arthrogram (a picture inside your joint) to rule out any tear in the shoulder socket tendons. If your shoulder imaging shows any tear in the shoulder socket tendons, then your doctor may suggest the following:

  • Arthroscopic arthroplasty: In this procedure, two or three keyhole-shaped cuts are made around your affected shoulder, and a thin fiberoptic scope (camera) is inserted into it. The surgeon examines the inside of your shoulder through a video camera. They may perform arthroplasty (removal of any bony growth or inflamed soft tissue to create more space for the rotator cuff). They may also perform acromioplasty (removal of some part of the tip of your shoulder).
  • Open arthroplasty: In open arthroplasty, your surgeon will make a small cut on the front side of your shoulder. They will inspect the shoulder joint condition directly and perform arthroplasty (repairing it by resurfacing the joint).

After the surgery, your arm may be placed in a sling for a short period to allow healing. Once your discomfort and pain resolve, your doctor will remove the sling. Then you will be instructed to start some shoulder-stretching exercises.

Your doctor will provide rehabilitation support based on your requirements and situation. Exercises are given after the shoulder surgery to help to regain a range of motions of your shoulder and strengthening your arm muscles. It generally requires two to four months to get complete relief from pain. However, some people may require a year.

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Medically Reviewed on 11/2/2020
References
American Academy of Osteopathic Surgeons https://orthoinfo.aaos.org/en/diseases--conditions/shoulder-impingementrotator-cuff-tendinitis

WebMD https://www.webmd.com/pain-management/rotator-cuff-impingement#1 https://www.webmd.com/arthritis/impingement-syndrome

NHS https://www.ouh.nhs.uk/shoulderandelbow/information/documents/A4ShoulderImpingeAppendix5.pdf https://www.nhs.uk/conditions/shoulder-impingement-syndrome/

Cleveland clinic https://health.clevelandclinic.org/the-best-way-to-find-relief-from-the-pain-of-shoulder-impingement/

The University of New South Wales, Australia (UNSW): Clinical Practice Guidelines for the Management of Rotator Cuff Syndrome in the Workplace