What is tendonitis (the impingement syndrome)?

This is the simplest condition because the syndrome is characterized by impingement with consequent swelling, inflammation, and pain, but without actual damage to any of the underlying tissues. The patient presents with pain on upward and/or outward motion of the shoulder. Often pain is brought on by repetitive overhead activities, such as throwing a ball or overhead serves in tennis. Patients will often report pain at night when trying to sleep on the side. On examination, the patient has no weakness. In addition, x-rays are generally normal. Furthermore, flexibility of the shoulder is fairly well maintained at this stage.. The impingement syndrome, left untreated, can lead to the other conditions mentioned above.

What is calcific tendonitis?

According to most clinicians, this is really not a separate clinical entity. As mentioned above, this term implies that in addition to the tendonitis which is generally seen in the impingement syndrome, there is a calcium deposit at the site of the injury. Unless the calcium is exceptionally large, this condition behaves exactly like the impingement syndrome, with the exception that x-rays would reveal the presence of a fleck of calcium. However, when the calcium is exceptionally large, then motion of the arm may cause an additional acute “wincing” pain. Treatment for this condition is most often no different than treatment for the impingement syndrome itself. This will be discussed later on.

What is bursitis?

In the shoulder, bursitis rarely occurs unless there is and underlying impingement syndrome. The term bursitis means that the shoulder “looks swollen”, that is, there is a sac of fluid which protects the shoulder joint and which is inflamed or “swollen” because of the underlying injury to the rotator cuff tendons. Patients will often complain of pain when their arms are unsupported. They feel better when their arms are up on a table or supported by a sling. This condition also is rarely treated differently than a simple impingement syndrome and the response to treatment and x-rays are almost never different with the impingement itself.

What is rotator cuff tear?

If the degree of injury to the tendon is not simply microscopic but is of greater magnitude, there may be an actual gross tear, partial or complete, of one or more tendons. In middle-aged people, this is usually the result of more significant trauma or of a neglected impingement syndrome. In older people, on the other hand, it is not uncommon for a simple elevation of the arm or a lifting task to result in a rupture of one of the rotator cuff tendons, often painlessly! In this condition, which is at the other end of the spectrum of disorders of the rotator cuff, there is usually actual weakness of the arm upon examination. In addition, a rotator cuff tear is characterized by more than simple inflammation, in the sense that rest and avoidance of aggravating factors will not in themselves reverse this process. IN a complete tear, if the patient is physically active and depends upon strength of the injured tissues, there are many instances where surgery is a necessity. On the other hand, it is not uncommon for patients with a partial rotator cuff tear to regain sufficient strength and function to avoid surgical intervention.