In most adults who present with atraumatic shoulder pain, symptoms arise from impingement syndromes (previously called rotator cuff tendonitis). These symptoms become more common as patients age.

The rotator cuff is made up of four muscle-tendon structures (supraspinatus, infraspinatus, teres minor, subscapularis) (Figure 7-1). Their combined activity is to move the shoulder through space and maintain the joint’s integrity. The symptoms of impingement can be managed initially by manual techniques. When followed by an aggressive physical therapy program, impingment syndrome can often be cured without surgery. Trauma-related shoulder pain is also often effectively treated without surgery, but an accurate diagnosis is needed as well as the recognition that failure to resolve may result in operative correction.