Shoulder bursitis and rotator cuff tendonitis are different ways of saying there is inflammation of a particular area within the shoulder joint that is causing a common set of symptoms. The proper terminology for these symptoms is ‘impingement syndrome.’ Impingement syndrome occurs when there is inflammation of the rotator cuff tendons and the bursa that surrounds these tendons. There is a difference between tendonitis and bursitis, but in most cases of impingement syndrome there is a combination of these problems.
The shoulder joint is a ball and socket type joint where the top part of the arm bone (humerus) forms a joint with the shoulder blade (scapula). The rotator cuff holds the head of the humerus into the scapula and controls movement of the shoulder joint.
The tendons of the rotator cuff pass underneath a bony area on their way to attaching the top part of the arm bone. When these tendons become inflamed, they can become more frayed over this area during shoulder movements. Sometimes, a bone spur may narrow the space even more.
This problem is called rotator cuff tendinitis, or impingement syndrome, and may be due to:
- Keeping the arm in the same position for long periods of time, such as doing computer work or hairstyling
- Sleeping on the same arm each night
- Playing sports requiring the arm to be moved over the head repeatedly as in tennis, baseball (particularly pitching), swimming, and lifting weights over the head
- Working with the arm overhead for many hours or days (such as in painting and carpentry)
- Poor control or coordination of your shoulder and shoulder blade muscles
- Poor posture over many years and the usual fraying of the tendons that occurs with age may also lead to rotator cuff tendinitis.
Rotator cuff tears may occur in two ways:
- A sudden or acute tear may happen when you fall on your arm while it is stretched out, or after a sudden, jerking motion when you try to lift something heavy.
- A chronic tear of the rotator cuff tendon occurs slowly over time. It is more likely in those with chronic tendinitis or impingement syndrome. At some point, the tendon wears down and tears.
There are two types of rotator cuff tears:
- A partial tear is when a tear does not completely sever the attachments to the bone.
- A complete or full thickness tear refers to a through and through tear. It may be as small as a pinpoint or all of the muscle tendon. Complete tears have detachment of the tendon from the attachment site and would not heal very well.
TENDINITIS OR IMPINGEMENT SYNDROME
Early on, pain occurs with overhead activities and lifting your arm to the side. Activities include brushing hair, reaching for objects on shelves, or playing an overhead sport.
- Pain is more likely in the front of the shoulder and may radiate to the side of the arm. However, this pain always stops before the elbow. If the pain travels beyond the arm to the elbow and hand, this may indicate a pinched nerve.
There may also be pain with lowering the shoulder from a raised position.
At first, this pain may be mild and occur only with certain movements of the arm. Over time, pain may be present at rest or at night, especially when lying on the affected shoulder.
You may have weakness and loss of motion when raising the arm above your head. Your shoulder can feel stiff with lifting or movement. It may become more difficult to place the arm behind your back.
ROTATOR CUFF TEARS
The pain with a sudden tear after a fall or injury is usually intense. Weakness of the shoulder and arm is often present, along with a snapping sensation of movement.
Symptoms of a chronic rotator cuff tear include a gradual worsening of pain, weakness, and stiffness or loss of motion. The exact point when a rotator cuff tear begins in someone with chronic shoulder tendinitis may or may not be noticed.
Most people with rotator cuff tendon tears have pain at night. Pain that is worse at night may wake you up. During the day, the pain is more tolerable and hurts with certain movements.
Over time, the symptoms become much worse and are not relieved by medicines, rest, or exercise.
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