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Shoulder Impingement / Rotator Cuff Tendinitis

 

 

Impingement


The shoulder is a ball and socket joint where the ball is the top of the arm bone (humerus) and the socket is part of the shoulder blade (scapula).  Above the humerus is a group of four muscles collectively known as the rotator cuff.  Above the rotator cuff there should be an empty space and a bursa sac (fluid filled sac to help with reducing friction).  Above the bursa sits the acromion which is the tip of the scapula and forms the roof of the shoulder joint.  This bone connects to the tip of the collarbone (clavicle) forming a joint called the acromioclavicular joint (AC joint).  Normally there is plenty of room for all of these structures to function.  However, overuse of the shoulder combined with other factors such as poor posture may lead to bursitis and tendonitis, collectively known as impingement.  Impingement causes the structures underneath the AC joint to be pinched against the bone causing irritation and pain.

 


Subacromial Decompression


This surgical procedure is performed to treat impingement by creating more space for the rotator cuff.  This procedure removes the inflamed portion of the bursa giving the rotator cuff more space thus reducing impingement symptoms.

 


Bone Spur Removal


This procedure is often performed concurrently with a subacromial decompression.  It is done to remove the underside of the acromion (tip of the shoulder blade) that may be “digging” into the rotator cuff causing inflammation and bursitis.

 


Distal Clavicle Excision


Removing the outer third of the clavicle may help alleviate some pain and loss of motion caused by impingement and/or arthritis.  The area where the bone is removed will fill-in with scar tissue which is more flexible reducing pinching of soft tissues against hard bone.

 


Biceps Tenodesis


This procedure involves the surgeon removing the damaged portion of the biceps tendon and reattaching the remaining portion of the tendon to the humerus.  Removing the damaged tissue can alleviate pain associated with the biceps tendon.

 


Biceps Tenotomy


This differs from the biceps tenodesis in that for this procedure, the biceps tendon is released entirely and is not repaired or reattached to the humerus.  This may have better results for a biceps tendon with more severe damage.  Although the biceps tendon is cut near the shoulder, there is very little strength loss at the shoulder or elbow.