II. Course

  1. Step 1: Small cuff tears from repetitive use injury (Athlete, Heavy Laborer)
  2. Step 2: Tendon scarring and thickening
  3. Step 3: Secondary irritation of overlying bursa
  4. Step 4: Thickened tendon and bursa (decreases sub-acromial space)
  5. Step 5: Impingement pain and crepitus (Provoked with abduction)

III. Symptoms

  1. Pain worse at night
  2. Shoulder tenderness and atrophy
  3. Unable to lie on affected Shoulder
  4. Locking Sensation with abduction
  5. Referred pain to deltoid
  6. Patient automatically turns palm up on abduction
    1. Externally rotates Shoulder
    2. Gives rotator cuff more room
  7. Active "palm down" abduction is painful

IV. Signs

  1. Supraspinatus insertion maximally tender
  2. Acromioclavicular Joint Pain from degenerative disease
  3. Muscle Strength intact
  4. Pain and crepitation
    1. Pain worse between 60 to 120 degrees abduction
    2. Soft tissue maximally compressed in subacromial space
  5. Shoulder Impingement Signs
    1. See Shoulder Evaluation

V. Imaging: Shoulder XRay

  1. Sclerosis at tuberosity may be seen
  2. Hook Acromion (Types 2-3) associated with impingement

VII. Management

  1. Relative Rest
    1. Avoid complete rest especially in older patients
      1. Risk of Frozen Shoulder
    2. Avoid excessive use
    3. Avoid all overhead work
    4. Sling for very limited time if necessary
  2. NSAIDs
  3. Moist heat applied 4 times daily
  4. Corticosteroid Injection at subacromial space
  5. Physical Therapy
    1. Local Ultrasound or Diathermy
    2. Phonophoresis (Ultrasound with Cortisone Cream)
  6. Exercise
    1. Shoulder Range of Motion Exercises

VIII. Prognosis

  1. Anticipate improvement in 3 to 5 weeks
  2. Delayed improvement suggests Rotator Cuff Rupture

IX. Management: Surgery

  1. Reserved for cases failing conservative treatment
  2. Procedures
    1. Partial acromion excision
    2. Release of obstructive soft tissue
    3. Repair of Rotator Cuff Tears

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Rotator Cuff Tendinitis (C0151448)

Concepts Disease or Syndrome (T047)
MSH D019534
SnomedCT 442520000
English Rotator cuff tendinitis, rotator cuff tendonitis, rotator cuff tendonitis (diagnosis), Inflammation of rotator cuff tendon, Tendinitis of rotator cuff, Inflammation of rotator cuff tendon (disorder), Rotator Cuff Tendinitis, rotator cuff tendinitis, tendinitis rotator cuff, cuff rotator tendinitis
Dutch rotator cuff-tendinitis
French Tendinite de la coiffe du rotateur, Tendinite de la coiffe des rotateurs
German Tendinitis der Rotatorenmanschette
Italian Tendinite della cuffia dei rotatori
Portuguese Tendinite da coifa dos rotadores
Spanish Tendinitis del manguito rotador, inflamación de tendón del manguito rotador, inflamación de tendón del manguito rotador (trastorno)
Japanese 肩回旋筋腱板炎, ケンカイセンキンケンバンエン, カタカイセンキンケンバンエン
Czech Tendinitida rotátorové manžety
Hungarian Rotatorköpeny tendinitis

Ontology: Shoulder Impingement Syndrome (C0376685)

Definition (MSH) Compression of the rotator cuff tendons and subacromial bursa between the humeral head and structures that make up the coracoacromial arch and the humeral tuberosities. This condition is associated with subacromial bursitis and rotator cuff (largely supraspinatus) and bicipital tendon inflammation, with or without degenerative changes in the tendon. Pain that is most severe when the arm is abducted in an arc between 40 and 120 degrees, sometimes associated with tears in the rotator cuff, is the chief symptom. (From Jablonski's Dictionary of Syndromes and Eponymic Diseases, 2d ed)
Concepts Disease or Syndrome (T047)
MSH D019534
ICD10 M75.4
SnomedCT 239960007, 366831005, 202851002, 128498000, 202849001
English Impingement Syndrome, Shoulder, Impingement Syndrome, Subacromial, Impingement Syndromes, Shoulder, Impingement Syndromes, Subacromial, Shoulder Impingement Syndrome, Shoulder Impingement Syndromes, Subacromial Impingement Syndrome, Subacromial Impingement Syndromes, Syndrome, Shoulder Impingement, Syndrome, Subacromial Impingement, Syndromes, Shoulder Impingement, Syndromes, Subacromial Impingement, Impingement syndrome of should, Shoulder Impingement Syndrome [Disease/Finding], subacromial impingement, impingement syndrome shoulder, shoulder syndrome impingement, subacromial impingement syndrome, shoulder impingement syndrome, Impingement syndrome shoulder, Impingement syndrome of shoulder, Shoulder impingement syndrome (disorder), Impingement syndrome of shoulder region, Subacromial impingement, Impingement syndrome of shoulder region (disorder), Shoulder impingement syndrome, Subacromial impingement (disorder), Shoulder impingement syndrome (disorder) [Ambiguous]
Dutch impingement schoudersyndroom, 'Impingement syndrome' van schouder, Impingement, subacromiale, Schouder-'impingement'-syndroom, Subacromiale 'impingement', Syndroom, schouder-'impingement'-
German Engpass-Syndrome der Schulter, Impingement-Syndrom der Schulter, Schulter-Impingementsyndrom, Subakromiales Impingementsyndrom
Italian Sindrome da interferenza della spalla, Sindrome da conflitto sub-acromiale, Sindrome da conflitto subacromiale, Sindrome da conflitto della spalla, Sindrome da conflitto sub acromiale, Sindrome del cercine glenoideo
Portuguese Síndrome de choque do ombro, Síndrome do Arco Doloroso, Síndrome de Pinçamento do Ombro, Síndrome de Pinçamento Subacromial, Síndrome do Supraespinal, Síndrome de Colisão do Ombro, Síndrome de Colisão Subacromial
Swedish Skulderinklämningssyndrom
French Tendinite de la coiffe des rotateurs de l'épaule, CSA (Conflit Sous-Acromial), Conflit sous-acromial de Neer, Conflit sous-acromial, Syndrome d'abutement de l'épaule, Syndrome d'accrochage de l'épaule, Syndrome d'accrochage sous-acromial, Syndrome du conflit sous-acromial, Épaule de conflit
Spanish ssíndrome de pellizcamiento en el hombro (trastorno), ssíndrome de pellizcamiento en el hombro, síndrome de pellizcamiento de hombro, síndrome de pellizcamiento en el hombro (trastorno), síndrome de pellizcamiento de hombro (trastorno), Síndrome de pinzamiento del hombro, síndrome de pellizcamiento en el hombro, síndrome de compresión del hombro, síndrome de compresión del hombro (trastorno), compresión subacromial, Síndrome de Abducción Dolorosa del Hombro, Síndrome del Arco Doloroso, Síndrome del Supraespinoso, Síndrome del Hombro Doloroso, Síndrome de Hombro Doloroso, pellizcamiento subacromial (trastorno), pellizcamiento subacromial, síndrome de compresión del hombro (concepto no activo), Síndrome de Pinzamiento del Hombro, Síndrome de Pinzamiento Subacromial
Japanese ケンインピンジメントショウコウグン, カタインピンジメントショウコウグン, 肩インピンジメント症候群, Impingement症候群, インピンジメント症候群, 肩峰下インピンジメント
Czech syndrom bolestivého ramene, syndrom subakromiálního zhmoždění, syndrom zhmožděného ramene, Impingement syndrom ramene
Finnish Ahdas olka
Korean 어깨의 충돌 증후군
Polish Zespół uciskowy pod wyrostkiem barkowym, Zespół ciasnoty barkowej, Zespół ciasnoty podbarkowej
Hungarian Impingement syndroma, váll
Norwegian Subakromiale skuldersmerter, Subakromialt syndrom, Rotator cuff tendinose, Rotator cuff disease, Rotator tendinose, Impingement syndrom i skulder, Inklemmingssyndrom i skulder