Shoulder Impingement: Bursitis and Tendonitis

Shoulder impingement is an irritation or inflammation of the bursa, the lubrication sac located just over the rotator cuff. This inflammation is called bursitis. Another type of shoulder impingement is inflammation of the rotator cuff tendons, called tendonitis.

How does shoulder impingement occur?

The bursa and tendons can become inflamed from repetitive shoulder motion. This can include overhead athletic activities such as swimming, tennis or throwing, or from occupational activities such as painting or carpentry.

What are the symptoms?

You may initially notice minor pain and a loss of strength, but it can progress into increasing discomfort when you lift your arm above your head, out to the side or reaching behind the body.

What is the treatment?

Treatment involves three steps. 

1. Once impingement is diagnosed, you need to avoid any painful activities or motions. Anti-inflammatory medications may help decrease inflammation or swelling in the bursa or tendons. Rotator cuff strengthening exercises are crucial to successful treatment, because when the rotator cuff muscles are strong, bursitis and tendonitis are less likely to occur.
2. Your doctor may recommend a cortisone injection, a direct-acting anti-inflammatory, to decrease inflammation and increase blood flow to the shoulder, which aids in healing.
3. You may need arthroscopic surgery to remove any bone spurs, open the space above the rotator cuff and remove the enlarged bursa. Surgery is an outpatient procedure that takes about 30 minutes. Rehabilitation time is 3-6 weeks.

What are the exercises?

Three main exercises effectively work the rotator cuff: Internal rotation, external rotation and supraspinatus. These exercises can be done with either rubber tubing, a pulley system at a gym or hand weights.

Internal Rotation

Internal rotation with weights is done by lying on your side, holding your lower arm bent at the elbow out to the side 90 degrees and slowly turning the arm inward towards the chest.

If using a band, attach it to a door or wall waist high and stand with your arm bent 90 degrees at the elbow. Holding the other end of the band, rotate the arm inward while your elbow remains at your side.

External Rotation

External rotation with weights is done while lying on your side, the upper arm bent 90 degrees at the elbow holding the weight and turning it out to the side/up.

If using a band, attach it to a door or a wall, crossing the tubing across your body into the opposite hand. Bend the arm 90 degrees at the elbow and slowly rotate the band outwards, pulling the band across the body.

Supraspinatus

Supraspinatus is done while standing, holding weights in both arms with the thumbs pointed downwards. Keep your elbows straight and slowly raise your arms out to the side 45 degrees to just below shoulder height. Bring the weight down slowly.

If using a band, place one end around the foot on the same side or opposite side; hold the other end of the band in your hand. Keep your elbow straight as you slowly raising the arm out to the side 45 degrees and up to just below shoulder height, while the thumb are pointed down. Slowly bring the arm down.

Each exercise must be PAIN-FREE. Do three sets of 20 repetitions. If you are unable to do 20 reps, decrease either the weight or the resistance.