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Impingement
The rotator cuff consists of four muscles that surround the ball and socket joint in the shoulder. Their role is to initiate shoulder movement and to stabilize the joint by compressing the ball against the socket when larger muscles such as the deltoid, trapezius, and latissimus are recruited to perform heavy lifting or overhead activities such as those in tennis or baseball. Overuse or acute injuries can cause pain in the rotator cuff. This is commonly referred to as rotator cuff tendinitis, impingement, or bursitis.
Patients present with complaints of pain with use of their arm overhead, away from their body or behind their back. This typically has gradual onset but may develop after an injury. Quite commonly this progresses to the point that they will have symptoms at night that may awaken them or make it difficult to fall asleep. Pain typically originates at the shoulder joint and will radiate down the arm. Numbness or tingling is usually not associated unless there is nerve irritation in the neck in conjunction with the shoulder pain. Patients may note some stiffness in the shoulder especially reaching behind their back. X-rays are typically normal and if an MRI is obtained it may show some mild fraying of the rotator cuff but no complete tear.
Treatment typically consists of conservative management initially. This will include physical therapy for strengthening of the rotator cuff and anti-inflammatory medications. In addition, if they have lost range of motion, joint stretching will also be included. Most of the time, this regimen will eliminate the pain and allow the patient to return to their usual activities. Occasionally if the patient is slow to recover or has significant symptoms a cortisone injection may be added. Patients that have worked on conservative management for several months without complete relief of their pain may want to consider a surgical approach. This consists of an arthroscopic procedure to evaluate the rotator cuff and to remove inflamed tissue surrounding the rotator cuff. This typically is an outpatient surgery utilizing a minimally invasive approach with 2 to 3 puncture wounds for the surgery. Patients will remain in a sling for a short time (7-10 days). Physical therapy is started to regain range of motion and improve strength. Return to sports and recreational activity usually occurs at 6 to 12 weeks. Results of this procedure have been demonstrated to be in the 85-95% good and excellent range.