Curriculum · Musculoskeletal / Orthopedic / Rheumatology
Rotator cuff tendinopathy and impingement
What it is
Rotator cuff pathologies are the most frequent cause of shoulder pain in adults, although they are uncommon in children. Rotator cuff impingement syndrome is the name used when subacromial tenderness, a painful arc and a positive Hawkins impingement sign are found in one shoulder. Impingement syndrome is also known as painful arc syndrome, and its underlying pathology is supraspinatus tendonitis.
Causes and risk
Pain in the shoulder of a young athlete can be caused by many problems, including acromioclavicular strain, biceps tendinitis, glenohumeral instability, and rotator cuff pathology. Unique to children is a repetitive use injury causing disruption at the proximal growth plate of the humerus, referred to as Little League shoulder. The three common shoulder pathologies sort by age. Instability is usually the young patient, with previous dislocations. Impingement syndrome is usually the middle-aged patient. Rotator cuff tear is usually the older patient.
How it presents
In impingement the shoulder pain begins to limit daily activities such as brushing the hair and reaching high shelves, and it wakes the patient at night, especially when lying on that side. Examination shows moderate subacromial tenderness, a positive painful arc at 90°, and a positive Hawkins impingement sign, while range of motion and abduction strength may still be normal. In a child with Little League shoulder the pain started gradually over the season of throwing, with pain when the arm is above the shoulder and tenderness to palpation of the proximal and lateral humerus. The painful arc is the classical sign of supraspinatus tendonitis: pain during shoulder abduction between 60° and 120°, due to impingement of the underside of the acromion on the inflamed tendon.