A Closer Look at That Aching Shoulder

By: Richard Maguire, MD

If you are an active person, chances are you've experienced shoulder pain at some time or another. In fact, shoulder pain is one of the most common complaints among active individuals. In most cases, the cause of shoulder pain is Impingement Syndrome, a wear-and-tear type injury of the shoulder. It's a condition that worsens when left untreated so it's important to know what symptoms to look out for.

In order to better understand Impingement Syndrome, one must first have an understanding of the anatomy of the shoulder. The rotator cuff is a group of four muscles responsible for elevating the shoulder and rotation of the arm. The rotator cuff surrounds the head of the shoulder bone but sits underneath another bone called the acromion. The rotator cuff is the only muscle in the human body to sit between two bones so it needs extra protection. In order to protect it, a padded structure called the bursa covers the muscles. In a normal shoulder, there is enough room between the bones for standard function of the muscles.

Shoulder pain rears its head when Impingement Syndrome causes swelling of the rotator cuff and bursa. This swelling closes down the space between the bones. This condition can result from a trauma, such as a fall, chronic overuse, or an acute overuse injury. When this swelling begins, the rotator cuff and bursa start to get pinched between the two bones and it's that pinching which causes pain. Many people find that the pinching sensation becomes worse when reaching above shoulder height, holding things away from one's body, pushing and pulling, and lying on the shoulder. The more pinching that occurs, the more damage is being done to the bursa and muscles. Untreated over a prolonged period of time, that pinching can eventually cause the rotator cuff to thin out and even tear.

If you have Impingement Syndrome, you're probably wondering what you can do about it. Here's the good news: the vast majority of people with this problem never need to have surgery. Treatment typically begins with physical therapy, anti-inflammatory medication, and icing. Physical Therapy consists of a regimented stretching and strengthening program as well as local anti-swelling procedures. When those treatments aren't quite enough, there's still another nonsurgical alternative, a cortisone injection. Cortisone is a steroid that acts as an anti-inflammatory. Physicians inject this medication into the space where the muscles and bursa are. Often this will decrease swelling enough to stop the pinching and relieve pain. These injections are typically more effective when combined with the other treatments mentioned earlier.

Unfortunately, despite all attempts, some people do end up needing to have surgery. When surgery is required, it's most likely because that person developed a rotator cuff tear. But there is still some good news for those that do find their condition requires surgery. The surgery to manage Impingement Syndrome is typically done arthroscopically. This means the surgery is done through small incisions with the help of a television camera. With arthroscopic surgery, recovery time is often shorter, due to the less-invasive nature of the procedure. The surgeon simply removes the swollen bursa and then shaves down the bone to make more room for the rotator cuff. After surgery, the patient gets back to their routine of physical therapy to stretch and strengthen the shoulder until before they know it, they've recovered enough to return to normal, everyday activities.

So while rotator cuff injuries can be a real pain, often they can be treated without surgical intervention. But because conditions such as Impingement Syndrome do worsen when left untreated, don't hesitate to see an Orthopaedist when you first feel that pinching sensation in your shoulder. You'll be glad you did!