Why do tendons get tight?
Between the head of the humerus and the acromion of the scapula there is a narrow subacromial space in which the supraspinatus tendon passes and the joint capsule lies. Normally, when you raise your arm, the head of the shoulder drops slightly, and there is enough space. If the rotator cuff muscles are weakened and the shoulder blade does not move properly, the head moves upward and presses the tendon against the bone. Swelling of the tendon and bursa further reduces the clearance. With age, the tendon tissue becomes less strong, and bone spines may form on the acromion, narrowing the space.
- Primary - narrowing due to the shape of the acromion and bone growths
- Secondary - due to cuff weakness and impaired scapular movement
- Accompanied by subacromial bursitis
- May be associated with a partial cuff tear
Causes and risk factors
Most often, the problem develops in people who work a lot with their arms raised: painters, plasterers, electricians, hairdressers, as well as athletes in swimming, volleyball, tennis, and throwing. The second big factor is a sedentary lifestyle and stooping: with a rounded back, the shoulder blade tilts forward, and the space under the acromion narrows at rest. With age, degenerative changes in the tendons occur. Shoulder injuries, joint instability and diabetes mellitus are also important.
- Working with your arms raised above your head
- Swimming, volleyball, tennis, throwing
- Weakness of the rotator cuff and scapula muscles
- Stooping and poor posture
- Age-related changes in tendons after 40 years
- Past injuries and shoulder dislocations
- Diabetes mellitus
Symptoms
The main symptom is pain when raising the arm to the side in the range of approximately 60 to 120 degrees: below and above this sector it is easier to move. It hurts to put your hand behind your back, reach your back pocket, fasten your bra, or reach the top shelf. Night pain is typical when lying on the affected side. The strength of the arm is initially preserved, but over time a feeling of weakness appears and movements become cautious. Complete immobility of the shoulder is not typical for impingement; it rather indicates adhesive capsulitis.
- Pain when raising the arm to the side at shoulder level
- Pain when placing your hand behind your back
- Night pain, especially on the affected side
- Difficulty getting dressed and working overhead
- Feeling of weakness and clicking in the shoulder
- Gradual onset without obvious trauma
Diagnostics
The diagnosis is mainly clinical. The doctor assesses range of motion, checks for a painful arch, and performs the Neer and Hawkins tests, in which the shoulder is elevated and internally rotated. Separately, the strength of individual cuff muscles is checked so as not to miss a tear, and the mobility of the cervical spine. An ultrasound of the shoulder joint shows the condition of the tendons, the presence of bursitis and fluid and is convenient because it allows you to examine the shoulder in motion. X-rays reveal bony spines, the shape of the acromion, and calcification of the tendon. MRI is prescribed if a cuff tear is suspected or before surgery.
- Assessing a painful arc of motion
- Neer and Hawkins tests
- Testing rotator cuff muscle strength
- Ultrasound of the shoulder joint
- X-ray of the shoulder joint
- MRI of the shoulder joint for suspected rupture
Treatment and prevention
The main thing in treatment is to restore proper muscle function. The program includes exercises to strengthen the rotator cuff, the muscles that stabilize the scapula, and stretch the posterior joint capsule; You need to do it regularly for several months. At the same time, overhead movements and heavy loads are temporarily eliminated, posture and workplace organization are corrected. Physical therapy - shock wave, laser, ultrasound therapy - helps reduce pain and makes exercise tolerable. Anti-inflammatory drugs are prescribed by the doctor for a short course. Injection of a glucocorticoid into the subacromial space is possible in case of severe pain, but it cannot be repeated many times. Arthroscopic surgery is considered if a full 3-6 month exercise program does not help.
- Exercises for the rotator cuff and scapula muscles
- Stretching the posterior capsule of the shoulder joint
- Temporary refusal to work and train overhead
- Correction of posture and workplace
- Shock wave and laser therapy
- Anti-inflammatory drugs as prescribed by a doctor
- Glucocorticoid injection for severe pain
- Arthroscopic decompression if treatment fails