There are many tests that can isolate specific areas of pain and weakness to help make the diagnosis. Further evaluation may include:. How are impingement and rotator cuff tears treated? Treatment for both injuries usually begins with a non-operative treatment plan. These results are lower in older patients and in those with large bone spurs. When trauma causes a tear in younger patients, surgery is often the first choice of treatment.
Patients with this type of injury recover best if surgery is done early. Generally, this pertains to those patients under the age of fifty with tears less than four weeks old. Non-operative treatment is similar for both impingement and rotator cuff tears.
A vast majority of patients improve with this primary treatment alone. The goals of a physical therapy program include:. Anti-inflammatory medication may be prescribed to help reduce pain and inflammation. Many patients with rotator cuff tears can function quite well if pain and inflammation are controlled with medication and physical therapy.
This is especially true for the elderly and those with low demands on the shoulder. If symptoms have not improved with this program, the doctor may recommend a steroid injection into the bursa.
Cortisone, or a similar steroid, is often combined with a local anesthetic to help control the pain and inflammation of the bursa. Steroid injections are used with caution. Damage to the rotator cuff tendons may occur with more than two or three injections over several months. Patients with diabetes are generally not good candidates for steroid injections because of problems with glucose control.
A non-operative treatment plan is often all that is necessary for most patients with impingement syndrome. However, the small percentage of patients whose symptoms have not improved after 6 months of dedicated physical therapy may be candidates for surgery. The shoulder should be reevaluated to make sure no other problems exist. Subacromial decompression expands the space between the acromion and rotator cuff tendons. This can be done either arthroscopically or with open incisions, depending on the preference of the surgeon.
During an arthroscopy, a tiny fiberoptic instrument is inserted into the joint. In many cases, the doctor can assess and repair the damage through this scope without making large incisions. Scar tissue or bone spurs can successfully be removed with either technique.
If a rotator cuff tear is found at the time of surgery, it can also be repaired if necessary. Not all rotator cuff tears require surgery. Many patients are content with their progress following a non-operative treatment plan.
Patients who have been unable to regain lost motion and strengthen the surrounding muscles sufficiently may need a rotator cuff repair. This is often the case for the younger, more active patients who want to address continued weakness following physical therapy. Rotator cuff repairs can be performed either arthroscopically or with open incisions.
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. 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. Post-surgical care for impingement and rotator cuff tears are similar. General care recommendations include:. Rotator cuff recovery is generally slower and requires more supervision.
In order to achieve a full and rapid recovery, surgery should be performed as soon as the patient has full range of motion and has gained good muscle strength from a physical therapy program started when the injury is first detected. After surgery, the patient follows a closely monitored program:. This answer to this question depends 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.
What is physical therapy likely to do to make mechanical impingement better? Physical therapy is the mainstay of treatment for impingement. The vast majority of patients improve with therapy and oral anti-inflammatory medication. 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. Generally speaking, a limited number 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.
These tendons help hold your arm in place, provide shoulder stability and enable movement. Damage to any one of the four rotator cuff muscles could result in inflammation and swelling and general pain in the shoulder, or cause shoulder impingement. Rotator cuff tears and impingement problems can exist separately or together. It is possible that rotator cuff tears are the result of impingement syndrome and age-related changes within the rotator cuff tendons.
Additionally, aging patients may develop arthritis which can cause bone spurs boney growths formed on a normal bone these further narrow the space below the acromion causing impingement. Again, this is common in older patients who participated in sports such as swimming, tennis, racquetball, baseball or work activities that require overhead positions. Unlike some rotator cuff tears, shoulder impingement symptoms are marked by pain. Motions such as reaching up behind the back or reaching up overhead to put on a coat or blouse, for example, will hurt.
Overhead motions tend to increase the pain drastically. The discomfort usually increases at night due to the amount of inflammation that builds during the day. A person may have one or more issues that leads to shoulder impingement, including:. People who have shoulder impingement can benefit from knowing its symptoms, the causes and risk factors, and how it is diagnosed and treated. Shoulder Dislocation Injury Dislocated Shoulder. The 3 Types of Shoulder Fractures. What to Know About Frozen Shoulder.
A Broken Shoulder: Scapula Fracture. Rotator Cuff Injuries: Symptoms.
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