Shoulder imp impingement syndrome / Rotator tendonitis

Anatomy

The shoulder is a very complex joint and is the most mobile joint in the human body. It is made up of three bones: the humerus (humerus), the scapula (scapula) and the clavicle. .

The glenoid cavity of the scapula is concave, covered by hyaline cartilage and enlarged by the glenoid labrum.

The joint capsule is the one that envelops the joint, inserting on the circumference of the glenoid cavity, but also on the external face of the glenoid labrum and on the anatomical neck.
Rotator cuff: above the capsule, a muscular layer surrounds the shoulder joint. It is made up of four short muscles that ensure not only most of the shoulder’s movements, but also its stability.
The subacromial bursa is very thin and contains a small amount of synovial tissue that interposes between the clavicle and acromion at the top and the humerus at the bottom. Its role is to facilitate sliding between the rotator cuff and the upper part of the shoulder.

Causes

Rotator cuff pain is a common problem for both young and middle-aged athletes. Young athletes who use their arms, rooting them overhead for swimming, baseball, tennis, are particularly vulnerable to this type of pain. Also vulnerable to this type of pain are construction workers, painters, or anyone who uses their arms repetitively.

Symptom

Pain due to rotator cuff injuries is associated with swelling and tenderness in the front of the shoulder. Pain and stiffness may occur when the arm is raised. There may also be pain when the arm is lowered from the raised position.

At first symptoms may be mild, which is why patients often do not seek treatment at an early stage. Symptoms may include:

• minor aches and pains both during some arm activities and at rest
• the pain goes from the front of the shoulder to the side of the shoulder
• sudden pain when lifting and grasping movements
• Athletes may experience pain when throwing a tennis ball, when raising their arms above their body.

When the condition worsens and symptoms increase:

• pain during the night
• loss of arm strength and limitation of arm movement
• difficulty doing activities that put your arm behind your back, such as buttoning buttons or zippers

If the pain comes on suddenly, the shoulder may already have serious problems. All movements may be restricted and painful.

Doctor’s examination
Medical history and physical examination
After discussing symptoms and medical history, the doctor will examine the shoulder. He or she will check the degree of movement of the shoulder or if pain occurs on mobilization. To measure the degree of motion in the shoulder, the doctor will have to move the arm in several directions. He will also test muscle strength.
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Imaging tests

Other tests that can help the doctor confirm the diagnosis are:

X-rays. Because X-rays do not show the soft parts of the shoulder, such as the rotator cuff, the radiologic images are usually normal or may show a small bone spur (osteophyte).

Magnetic resonance imaging (MRI) and ultrasound. These tests can show more detailed images of soft parts such as the rotator cuff tendons. They can show subacromial bony deposits, subacromial burstitis, inflammation of the rotator cuff tendons, sometimes partial or complete rupture of the rotator cuff tendons, synovitis, capsular or labral lesions.
Treatment

The aim of treatment is to reduce pain and restore shoulder function. For treatment planning, the doctor will take into account your age, daily activity level and general state of health.

Non-surgical treatment

In most cases, initial treatment is non-surgical. Although non-surgical treatment may last several weeks or months, many patients show a gradual improvement and return to daily activities.

Repaus. Medicul va poate recomanda repaus si schimbari in activitatile zilnice, cum ar fi evitarea activitatilor sportive, ca de exemplu tenisul, innotul etc.

Anti-inflammatory drugs reduce pain and inflammation in the shoulder.

Kinetoterapia. Un kinetoterapeut se va concentra initial pe restabilirea miscarilor normale ale umarului, prin exercitii de stretching. Daca aveti dificultati in a ajunge cu bratul la spate, este posibil sa fi aparut o retractie a capsulei posterioare a umarului (capsula se refera la captuseala interioara a umarului). Intinderi specifice ale capsulei posterioare pot fi foarte eficiente in ameliorarea durerii umarului si in recastigarea mobilitatii.

Steroid injections. If rest, medication and physiotherapy do not relieve the pain, an infiltration with an anesthetic and cortisone can be helpful. Cortizone is a very effective anti-inflammatory drug. Injecting it into the subacromial bursa can relieve pain.

Surgical treatment

When non-surgical treatment does not relieve the pain, your doctor may recommend surgery.

The goal of surgery is to create more space for the rotator cuff tendons. To do this, the doctor will remove the inflamed portion of the bursa. He may also perform an anterior acromioplasty, in which part of the acromion is removed. This is also known as a subacromial decompression. These procedures can be performed either using arthroscopic technique or open surgery.

Arthroscopic technique. In arthroscopy, thin surgical instruments are inserted through two or three small incisions in the shoulder. The doctor examines the shoulder through a fiber-optic instrument connected to a video camera (arthroscope). In most cases, the front edge of the acromion is removed, along with part of the subacromial bursa.

Ortopedul. Poate trata, de asemenea si alte probleme ale umarului. Acestea pot include artrita dintre clavicula si acromion (artrita acromioclaviculara), inflamatia tendonului bicepsului, sau o ruptura partiala a tendoanelor coafei rotatorii.

Classic surgery. The doctor will make a small incision in the front of the shoulder. This allows the doctor direct visibility of the acromion and rotator cuff.

Recuperare. Dupa operatie, bratul poate fi imobilizat intr o esarfa pentru o perioada scurta de timp. Acest lucru permite o vindecare mai rapida.Medicul va va oferi un program de recuperare in functie de leziunile avute si de rezultatul interventiei chirurgicale Acesta va include exercitii pentru recuperarea miscarilor de umar si cresterea fortei bratului. Acesta, de obicei durează 2-4 luni pentru disparitia completa a durerii, dar poate dura uneori si pana la un an de zile.