Shoulder Conditions: Rotator Cuff Injuries and Bursitis

Subacromial impingement/pain syndrome is a common cause of shoulder pain that encompasses a spectrum of pathology of the subacromial bursa and rotator cuff tendons. Pathology of the rotator cuff tendons can range from inflammation to fibrotic changes to partial- and full-thickness tears. Biomechanical dysfunction of the rotator cuff and glenohumeral complex contributes to the pathophysiology and progression of subacromial impingement/pain syndrome. The most common risk factor for subacromial pain and rotator cuff tendinopathy is repetitive overhead activity. Rotator cuff conditions typically manifest with an insidious onset of pain but also can be the result of acute injury. Magnetic resonance imaging study and ultrasonography may be useful to evaluate for soft tissue pathology, depending on the level of clinical concern regarding rotator cuff tear. Management of rotator cuff conditions depends on multiple factors, including chronicity, underlying anatomic and biomechanical factors, age, and the presence and degree of tendon tears. Management typically starts with conservative care such as physical therapy, anti-inflammatory drugs, and injection therapies but eventually may include surgical repair.