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Shoulder Tendinitis And Impingement
Dr Kau Chung Yuan (许医生)
MBBS (S’PORE)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
What is Shoulder Tendinitis and Impingement?
Shoulder tendinitis and impingement are conditions that affect the shoulder joint, causing pain and restricted movement. Shoulder tendinitis refers to the inflammation of the tendons in the shoulder, particularly those in the rotator cuff and bicep. It is often associated with overuse and repetitive activities, leading to irritation and swelling of the tendons.
Shoulder impingement syndrome, on the other hand, occurs when the rotator cuff tendons are trapped and compressed during shoulder movements. This compression can lead to irritation and injury of the tendons and bursa (a small fluid-filled sac that provides cushioning between bones and tendons) in the shoulder.
These conditions can co-exist as shoulder impingement can lead to tendinitis, and prolonged tendinitis can increase the risk of impingement. Both conditions are common in individuals who engage in activities that involve repetitive overhead motions, such as painting, lifting, swimming, or certain sports.
Causes
The causes of shoulder tendinitis and impingement are often multifactorial, involving a combination of anatomical, physiological, and activity-related factors.
Anatomical Factors
- Subacromial Space Narrowing: Genetic or acquired anatomical variations that reduce the subacromial space can predispose individuals to impingement.
- Rotator Cuff Weakness: Weakness in the rotator cuff can lead to instability in the shoulder joint, increasing the risk of tendinitis and impingement.
- Bony Abnormalities: Bone spurs or variations in the shape of the acromion can lead to increased friction and impingement.
Physiological Factors
- Age-related Degeneration: Tendons lose elasticity and become more susceptible to injury with age.
- Inflammatory Processes: Conditions like arthritis can contribute to inflammation in the shoulder, exacerbating tendinitis and impingement.
Activity-Related Factors
- Repetitive Overhead Activities: Sports, occupations, or hobbies involving repetitive overhead movements can strain the shoulder tendons and muscles.
- Poor Technique in Sports or Exercise: Incorrect form or overuse in activities can lead to excessive stress on the shoulder.
- Trauma: Acute injuries to the shoulder can initiate a cycle of inflammation and impingement.
Symptoms
The symptoms of shoulder tendinitis and impingement are crucial for early diagnosis and effective management of these conditions. Initially, symptoms may occur only during activities but can progress to being present at rest if the condition is not treated.
Common Symptoms
- Pain: Often felt in the front of the shoulder and may radiate down the arm. It typically worsens with overhead activities or at night.
- Weakness: Decreased strength in the shoulder, particularly when lifting or rotating the arm.
- Limited Range of Motion: Difficulty and discomfort during movements, especially raising the arm overhead.
- Swelling and Tenderness: In the affected area, often exacerbated by activity.
Specific Symptoms for Impingement
- Painful Arc: Discomfort or pain when lifting the arm between 60 to 120 degrees.
- Night Pain: Increased pain when lying on the affected shoulder.
- Crepitus: A crackling or grating feeling or sound in the shoulder during movement.
Diagnosis
Diagnosing shoulder tendinitis and impingement involves a combination of clinical evaluation and diagnostic tests.
Clinical Evaluation
- Medical History: Assessing symptoms, activity level, and any history of shoulder problems.
- Physical Examination: Checking for pain, tenderness, swelling, range of motion, and strength in the shoulder. Specific tests, like the Neer and Hawkins tests, may be conducted to provoke symptoms of impingement.
Imaging Tests
- X-rays: Useful for identifying bone spurs or changes in bone structure that may contribute to impingement.
- Ultrasound: Can visualise soft tissue structures, including the tendons and bursa, and assess their condition.
- Magnetic Resonance Imaging (MRI): Provides detailed images of the shoulder’s soft tissues, helping in identifying tears or inflammation.
Non-Surgical Treatment Options
The majority of cases of shoulder tendinitis and impingement can be effectively managed with non-surgical treatments. These aim to reduce pain, decrease inflammation, and improve shoulder function.
- Rest
Avoiding activities that exacerbate symptoms is often the first step in treatment. - Ice Packs
Applying ice can help reduce inflammation and pain. - Physical Therapy
Tailored exercises to strengthen the shoulder and improve range of motion. - Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Medications like ibuprofen can help manage pain and reduce inflammation. - Corticosteroid Injections
These injections into the shoulder can provide temporary relief from pain and inflammation. - Activity Modification
Changing or modifying activities that cause symptoms can prevent further irritation. - Occupational Therapy
Focused on improving daily functioning and reducing strain on the shoulder during activities.
Surgical Treatment Options
Surgical intervention for shoulder tendinitis and impingement is considered when non-surgical treatments are ineffective or in cases of severe structural damage.
- Subacromial Decompression: This surgery involves removing bone spurs and inflamed bursa from the subacromial space, the area between the acromion and the rotator cuff. The goal is to create more room for the rotator cuff, reducing impingement and alleviating pain and irritation. This procedure can be performed arthroscopically, involving small incisions and the use of a camera and instruments to visualise and treat the affected area.
- Rotator Cuff Repair: This procedure is performed to repair torn rotator cuff tendons. The orthopaedic surgeon reattaches the torn tendon to the head of the humerus (upper arm bone). Depending on the extent of the tear, this can be done through traditional open surgery, a mini-open repair combining arthroscopy and a smaller incision, or entirely through arthroscopy.
- Arthroscopy: A minimally invasive surgical technique used both for diagnosing and treating shoulder problems. During arthroscopy, a small camera (arthroscope) is inserted into the shoulder joint through a small incision. Additional small incisions allow the surgeon to use specialised instruments to repair damaged tissues.
Dr. Kau Chung Yuan
MBBS (S’pore)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
Dr Kau (许医生) is a Fellowship trained Orthopaedic Surgeon with a subspecialty interest in Hip and Knee surgery and has been in practice for more than 15 years.
He is experienced in trauma and fracture management, sports injuries, and joint replacement surgery.
- Fellow of the Royal College of Surgeons Edinburgh, Orthopaedics (FRCS, Edin) 2014
- Master of Medicine (Orthopaedics), Singapore (MMed) 2013
- Member of the Royal College of Surgeons Ireland (MRCS, Ire) 2009
- Bachelor of Medicine and Surgery (MBBS, Singapore) 2004
Prevention Measures
Implementing prevention strategies is key to reducing the risk of developing shoulder tendinitis and impingement.
- Strengthening Exercises
Focus on exercises that strengthen the rotator cuff and surrounding muscles to support and stabilise the shoulder joint. - Ergonomic Adjustments
For those involved in repetitive shoulder activities, modifying workplace ergonomics can help reduce strain on the shoulder. - Proper Techniques in Sports
Utilise correct form and equipment in sports to minimise the risk of shoulder injuries. - Lifestyle Changes
Maintain overall fitness and a healthy weight to decrease the burden on shoulder joints. - Regular Check-ups
Especially important for athletes or individuals with a history of shoulder issues, periodic evaluations can help in early detection and prevention of problems.
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Frequently Asked Questions (FAQs)
What are the Main Differences Between Shoulder Tendinitis and Impingement?
Shoulder tendinitis refers to inflammation of the tendons, primarily in the rotator cuff and bicep, often due to overuse or repetitive motion. Impingement syndrome occurs when these tendons are compressed during shoulder movements, leading to irritation and inflammation. Tendinitis can lead to impingement and vice versa, but they have distinct mechanisms.
Can Shoulder Tendinitis and Impingement Be Completely Cured?
With appropriate treatment, many individuals can achieve significant relief from symptoms. Complete recovery is possible, especially when the condition is diagnosed and treated early. However, in some chronic or severe cases, ongoing management may be necessary.
How Can I Differentiate Between Shoulder Tendinitis/Impingement Pain and Other Types of Shoulder Pain?
Shoulder tendinitis and impingement typically present with pain in the front of the shoulder, often worsening with overhead activities. A distinctive feature of impingement is the painful arc experienced when lifting the arm. Consultation with an orthopaedic surgeon is important for accurate diagnosis, as symptoms can overlap with other shoulder conditions.
What are the Long-Term Effects of Ignoring Shoulder Tendinitis and Impingement?
Ignoring these conditions can lead to worsening pain, decreased range of motion, and potential progression to more serious issues such as rotator cuff tears. Chronic pain and functional limitations can also occur if left untreated.