Rotator cuff impingement restricts normal movement in a group of muscles and tendons in your shoulder known collectively as the rotator cuff. The condition is also sometimes called rotator cuff tendinitis. Physical therapy approaches for healing an impingement vary, according to the method used to treat your injury.
Understanding Impingement
Your rotator cuff includes your infraspinatus, supraspinatus, teres minor and subscapularis muscles, as well as the tendons that attach these muscles to the bones in your shoulder joint. Rotator cuff impingement occurs when the tendon attached to your supraspinatus muscle gets trapped or pinched in the channel created by your humerus and a portion of your shoulder blade called the acromion. Symptoms associated with impingement include swelling, inflammation and pain.
If rotator cuff impingement occurs repeatedly over time, your supraspinatus tendon can start to break down or even tear completely. Factors that can lead to impingement include habitual performance of overhead motions, the thickness and shape of your acromion and the presence of abnormal bone growths called bone spurs.
Therapy Without Surgery
Most of the time, your doctor will try to heal a rotator cuff impingement with nonsurgical treatments, the American Academy of Orthopaedic Surgeons explains. After you rest your arm and reduce any pain or swelling, your physical therapist will ask you to perform stretching exercises designed to restore your shoulder's previous range of motion. Once your pain levels drop sufficiently, your therapist will add strengthening exercises that will make your shoulder joint more resistant to future damage.
Nonsurgical Therapy Considerations
In addition to exercises for your rotator cuff, your physical therapist may ask you to perform exercises designed to strengthen the other muscles that help to form your shoulder joint. If you don't get relief from rest, physical therapy and oral pain medications, your doctor may give you a shot of an anti-inflammatory drug called cortisone. Typically, he will inject this drug into a fluid-filled structure under your acromion called a bursa, which normally reduces friction in your shoulder and eases movement.
Therapy After Surgery
If nonsurgical treatments don't work, your doctor will likely recommend surgery to widen the space available to your rotator cuff. During surgery, your doctor will get a precise picture of your shoulder problems and pass his findings on to your physical therapist. Your therapist will then use this information to create a stretching and strengthening program that fits your specific shoulder condition. Typically, you will begin this program after a short period of arm immobilization. In most cases, you will gain pain-free function in your shoulder within two to four months, although some people don't regain shoulder function until a full year has passed.
References
- American Academy of Orthopaedic Surgeons: Shoulder Impingement/Rotator Cuff Tendinitis; February 2011
- PubMed Health: Rotator Cuff Tendinitis; August 24, 2009
- Southern California Orthopedic Institute: Rotator Cuff Disease/Impingement Syndrome; Frequently Asked Questions; 2010
- American Orthopaedic Society for Sports Medicine: Shoulder Impimgement; 2008
