Swimmer's shoulder; Pitcher's shoulder; Shoulder impingement syndrome; Tennis shoulder

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.

Inflammation of the tendons of the shoulder muscles can occur in sports requiring the arm to be moved over the head repeatedly as in tennis, baseball (particularly pitching), swimming, and lifting weights over the head. Chronic inflammation or injury can cause the tendons of the rotator cuff to tear.

The risk factors are being over age 40 and participation in sports or exercise that involves repetitive arm motion over the head (such as baseball).

• Pain associated with arm movement
• Pain in the shoulder at night, especially when lying on the affected shoulder
• Weakness with raising the arm above the head, or pain with overhead activities (brushing hair, reaching for objects on shelves, etc.)

A physical examination will reveal tenderness over the shoulder. Pain may occur when the shoulder is raised overhead. There is usually weakness of the shoulder when it is placed in certain positions.

X-rays may show a bone spur, while MRI may demonstrate inflammation in the rotator cuff. If a tear in the rotator cuff is present, this can usually be identified on MRI.

The injured shoulder should be rested from the activities that caused the problem and from activities that cause pain. Ice packs applied to the shoulder and non-steroidal anti-inflammatory drugs will help reduce inflammation and pain.

Physical therapy to strengthen the muscles of the rotator cuff should be started. If the pain persists or if therapy is not possible because of severe pain, a steroid injection may reduce pain and inflammation enough to allow effective therapy.

If the rotator cuff has sustained a complete tear, or if the symptoms persist despite conservative therapy, surgery may be necessary. Arthroscopic surgery can remove bone spurs and inflamed tissue around the shoulder.

Small tears can be treated with arthroscopic surgery. Newer techniques allow even large tears to be repaired arthroscopically, although some large tears require open surgery to repair the torn tendon.

Most people recover full function after a combination of medications, physical therapy, and steroid injections. For patients with tendinitis and a bone spur, arthroscopic surgery is usually successful in restoring them to their pre-injury level of activity.

People with tears of their rotator cuff tend to do well, although their outcome is strongly dependent upon the size and duration of the tear, as well as their age and pre-injury level of function.

• Bursitis
• Complete rotator cuff tear
• Treatment fails to improve symptoms

Call for an appointment with your health care provider if persistent shoulder pain occurs. Also call if symptoms do not improve with treatment.

Avoid repetitive overhead movements. Develop shoulder strength in opposing muscle groups.