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. Click here for more information.

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.
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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.
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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. Click here for
more information.

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.