Torn Rotator Cuff & Shoulder Impingement Syndrome Frequently Asked Questions

The two most common causes of shoulder pain impingement syndrome and a rotator cuff tear. These two problems occur in the narrow space between the bones of the shoulder and can exist separately or together. Click here for more information.
The shoulder is the most mobile joint in the human body with a complex arrangement of bone and soft tissue (ligaments, tendons, and muscles) that work together to produce shoulder movement. Click here for more information.

Shoulder impingement syndrome occurs when the tendons of the rotator cuff and the subacromial bursa are pinched in the narrow space beneath the acromion. There are three grades of impingement:
Grade 1: is marked by inflammation of the bursa and tendons
Grade 2: has progressive thickening and scarring of the bursa
Grade 3: occurs when rotator cuff degeneration and tears are evident
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Rotator cuff tears can be the result of a traumatic injury or deterioration over time. Symptoms may be present, but in many cases, the patient experiences no symptoms at all. Continual irritation to the bursa and rotator cuff tendons can lead to deterioration and tearing of the rotator cuff tendons.

Impingement symptoms are marked by pain; sharp and intermittent in the early stages becoming more constant. Overhead motions tend to increase pain. Click here for more information.
The symptoms of a rotator cuff tear are very similar to those of impingement syndrome with the added complaint of weakness. Click here for more information.
With a careful history and physical examination, impingement and rotator cuff tears can be easily diagnosed in the doctor’s office. Further testing may be necessary to determine the exact nature of a rotator cuff tear. After evaluating the symptoms, your doctor will perform a muscle test to determine if there are tears in the rotator cuff tendons and rule out other conditions. A diagnostic injection, X-rays, MRI, arthrogram, and/or ultrasound may also be ordered. Click here for more information.
More than 2/3 of patients can expect significant improvement in their symptoms with a physical therapy program and anti-inflammatory medication. Click here for more information.
Both surgeries can be down performed either arthroscopically or with open incisions. Subacromial decompression is the surgery performed to expand the space between the acromion and rotator cuff tendon to relieve the shoulder impingement. In rotator cuff tear repair arthroscopic techniques are new and limited to specific types of tears. An open repair that secures the rotator cuff tendons back to the humerus remains the surgical treatment of choice. Click here for more information.

Complication rates after surgery are generally low. Pre-operative antibiotics are given to reduce the slight risk of infection after surgery. Infection tends to occur a little less often
when arthroscopic techniques are used. Risks of major bleeding or nerve damage are extremely small. Postoperative stiffness is the major complication of both impingement
and rotator cuff tears. Click here for more information.

Incisions must be kept dry for two or three days after surgery, sutures are removed 7 – 10 days after surgery. In rotator cuff surgery recovery there is no active use of the shoulder for the first six weeks. The rehabilitation program includes carefully controlled physical therapy for six to twelve weeks. The first goal is to regain motion within three months. Full recovery can take six months. In impingement surgery recovery exercises to regain shoulder motion usually being immediately and continue for six weeks. Full recovery time can vary with most gaining great improvement within three months and are close to normal within six months. Click here for more information
Depending on the condition of the other shoulder muscles and the age of the patient. Many older patients have no symptoms with a rotator cuff tear and continue to function without pain or disability. The goal of physical therapy is to maximize the function of the remaining tendons, and hopefully avoid surgery. In the younger age groups, particularly when tears are caused by a sudden injury, early surgery is generally recommended to insure a successful treatment outcome. Click here for more information.

Strong rotator cuff muscles can relieve impingement symptoms by exerting a downward force on the humeral head, opening up the space available under the acromion. Spurs that develop beneath the acromion cannot be resolved with physical therapy, but the healthier the rotator cuff is, the less likely it is that surgery will be required.

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Generally speaking, a limited number (3-5) of steroid injections into the bursa are a safe, and often effective way to locally reduce inflammation and alleviate pain. These locally applied steroids do not have the same risks associated with the chronic use of oral steroids since the body does not systemically absorb them. However, it has been shown that repeated steroid injections can damage the quality of the rotator cuff tendons if a repair is later required. Click here for more information.
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