Anatomy
  • Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).
  • Your arm is kept in your shoulder socket by your rotator cuff. These muscles and tendons form a covering around the head of your upper arm bone and attach it to your shoulder blade. These muscles are called Supraspinatus, Infraspinatus, Teres Minor, Subscapularis
  • There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). The bursa allows the rotator cuff tendons to glide freely when you move your arm.
Description
  • Tendonitis – The rotator cuff tendons can be irritated or damaged. This can further progress to calcified deposits on the tendon limits its ability to function.
  • Bursitis – The bursa can become inflamed and swell with more fluid causing pain. Bursitis is a common reason for impingement syndrome.
  • Impingement – When you raise your arm to shoulder height, the space between the acromion and rotator cuff narrows naturally. The acromion can rub against (or “impinge” on) the tendon and the bursa, causing irritation and pain. This can further exacerbate bursitis and tendonitis.
Causes
  • Common in both young athletes and middle aged people
  • Repetitive lifting or overhead activities using the arm
  • Improper body mechanics
  • Shoulder instability (frequent dislocations)
  • Diabetics are at increased risk
Symptoms
  • Commonly causes local swelling and tenderness in the front of the shoulder.
  • Early symptoms include:
    • Minor pain that is present both with activity and at rest
    • Pain radiating from the front of the shoulder to the side of the arm
    • Sudden pain with lifting and reaching movements, especially above the shoulder
    • Athletes in overhead sports may have pain when throwing or serving a tennis ball
  • As the problem progresses, the symptoms increase:
    • Pain at night
    • Loss of strength and motion
    • Difficulty doing activities that place the arm behind the back, such as buttoning or zippering
Treatment
  • Rest. Avoiding movements that exacerbate your pain.
  • Heat and Ice can be applied to reduce pain and swelling. Apply for 20 minutes at a time, several times a day, to keep swelling down. Do not apply directly to the skin.
  • Nonsteroidal anti-inflammatory medicines. Drugs like ibuprofen and naproxen reduce pain and swelling. Like any over the counter medication, please read and follow the label. If you have a history of stomach ulcers, bleeding ulcers or heart conditions, these medications might not be right for you. Consult your physician if you have any questions.
  • Physiotherapy. Under the direction of an experienced physiotherapists, many patients do well by:
    • Increasing Range of motion exercises and flexibility
    • Massage and TENS
  • Topical anti-inflammatories
    • Compound Topical Creams
    • Voltaren
  • Injections
    • Steroid (Depo-Medrol, Kenalog, Decadron)
    • Blood (PRP – Platelet Rich Plasma)