One of the most common physical complaints is shoulder
pain. Your shoulder is made up of several joints combined
with tendons and muscles that allow a great range of motion
in your arm. Because so many different structures make up
the shoulder, it is vulnerable to many different problems.
The rotator cuff is a frequent source of pain in the
Your shoulder is made up of three bones: your upper arm
bone (humerus), your shoulder blade (scapula), and your
Your arm is kept in your shoulder socket by your rotator
cuff. These muscles and tendons form a covering around the
head of your upper arm bone and attach it to your shoulder
There is a lubricating sac called a bursa between the
rotator cuff and the bone on top of your shoulder
(acromion). The bursa allows the rotator cuff tendons to
glide freely when you move your arm.
Impingement. When you raise your arm to
shoulder height, the space between the acromion and rotator
cuff narrows. The acromion can rub against (or "impinge" on)
the tendon and the bursa, causing irritation and pain.
Rotator cuff pain is common in both young athletes and
middle-aged people. Young athletes who use their arms
overhead for swimming, baseball, and tennis are particularly
vulnerable. Those who do repetitive lifting or overhead
activities using the arm, such as paper hanging,
construction, or painting are also susceptible.
Pain may also develop as the result of a minor injury.
Sometimes, it occurs with no apparent cause.
Rotator cuff pain commonly causes local swelling and
tenderness in the front of the shoulder. You may have pain
and stiffness when you lift your arm. There may also be pain
when the arm is lowered from an elevated position.
Beginning symptoms may be mild. Patients frequently do
not seek treatment at an early stage. These symptoms may
- Minor pain that is present both with activity and at
- Pain radiating from the front of the shoulder to the
side of the arm
- Sudden pain with lifting and reaching movements
- Athletes in overhead sports may have pain when
throwing or serving a tennis ball
As the problem progresses, the symptoms increase:
- Pain at night
- Loss of strength and motion
- Difficulty doing activities that place the arm
behind the back, such as buttoning or zippering
If the pain comes on suddenly, the shoulder may be
severely tender. All movement may be limited and painful.
treatment does not relieve pain, your doctor may recommend
The goal of surgery is to create more space for the
rotator cuff. To do this, your doctor will remove the
inflamed portion of the bursa. He or she may also perform an
anterior acromioplasty, in which part of the acromion is
removed. This is also known as a subacromial decompression.
These procedures can be performed using either an
arthroscopic or open technique.
Arthroscopic technique. In arthroscopy,
thin surgical instruments are inserted into two or three
small puncture wounds around your shoulder. Your doctor
examines your shoulder through a fiberoptic scope connected
to a television camera. He or she guides the small
instruments using a video monitor, and removes bone and soft
tissue. In most cases, the front edge of the acromion is
removed along with some of the bursal tissue.
Your surgeon may also treat other conditions present in
the shoulder at the time of surgery. These can include
arthritis between the clavicle (collarbone) and the acromion
(acromioclavicular arthritis), inflammation of the biceps
tendon (biceps tendonitis), or a partial rotator cuff tear.
Open surgical technique. In open
surgery, your doctor will make a small incision in the front
of your shoulder. This allows your doctor to see the
acromion and rotator cuff directly.