What Is Impingement Of The Rotator Cuff?
Impingement is the impact of bone into the rotator cuff tendon or bursa. This impingement should not occur during normal shoulder function and when it does happen, the rotator cuff tendon becomes inflamed and swollen. This inflammation and swelling is known as rotator cuff tendonitis, if as a result of impingement it is the bursa that becomes inflamed, then it is know as bursitis. Both conditions of bursitis and tendonitis can co-exist or present independently, here we will discuss impingement with regard to rotator cuff impingement syndrome.
What Is The Impingement Zone?
The impingement zone in bursitis or rotator cuff impingement syndrome refers to postures and positions that significantly narrow the subacromial space. These are positions in which the space below the acromion where these rotator cuff tendons pass and the bursa sits are compromised including:
- When your arm is directly overhead.
- When your arm is at (or near) shoulder height.
Who Typically Suffers With Rotator Cuff Impingement Syndrome?
There are a few risk factors for rotator cuff impingement syndrome such as:
- Smoking. Smokers carry in increased risk of rotator cuff impingement syndrome and this could be related to the fact that nicotine can affect sensory thresholds, impair vasculature to tendons and disturb tendon healing capacity.
- Sleeping position. Sleeping on your front or side with your arm up in forward elevation and hand pointing towards your face puts the shoulder in the impingement zone for extended periods.
- Occupations. Jobs that require repeated overhead lifting or working at or above shoulder height are also at risk of rotator cuff impingement syndrome. Occupations considered high risk include painters and slaughterhouse workers.
Impingement syndrome is also more likely to occur in people who engage in physical activities that require repeated overhead arm movements including but not exclusively:
Symptoms Of Rotator Cuff Impingement Syndrome?
Impingement of the rotator cuff tendons commonly has the following symptoms:
- A painful arc of shoulder movement where pain is felt when your arm is at shoulder height and overhead. Meaning there is often pain when putting your hand behind your head and sometimes behind your back and doing activities like reaching for your seatbelt.
- People will often experience muscle weakness or pain when attempting to reach for or lift objects.
- The shoulder pain is felt from the top of the shoulder and outside of the upper arm extending sometimes down towards the elbow.
- Pain is felt when lying on the sore side.
- Shoulder pain may even be experienced when at rest as the condition deteriorates.
Diagnosis Of Rotator Cuff Impingement Syndrome
A physiotherapist in most cases will be able to diagnose rotator cuff impingement syndrome following questioning you about the condition and clinical examination of the shoulder using some specific tests that identify or exclude impingement signs. The use of specific investigations may also help with diagnosis. Assessment may include the request for X-rays, ultrasound scans or an MRI. These investigations can help look for the presence of swelling, degeneration or tears in the rotator cuff as well as signs of bursitis. Also X-rays are useful in investigating the presence of a hook type acromion which has been shown to have a higher incidence of rotator cuff problems with this particular acromial shape.
Disclaimer: Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance regarding Rotator Cuff Impingement Syndrome should consult his or her orthopaedic surgeon, general practitioner, sports medicine specialist or physiotherapist.