Shoulder Impingement
Shoulder anatomy
The shoulder joint can be described as similar to a golf ball (the top of the arm bone) sitting on a tee (a shallow depression in the scapula or shoulder blade), from which it can easily fall off! The shoulder is one of the most mobile joints in the body which makes it a common site of injury. The necessary stability and mobility of the shoulder are provided by the rotator cuff, a group of ligaments, tendons and muscles that surround the joint and anchor the bones in the socket.
With activity, sometimes the soft tissues can become pinched between the bones and shoulder ligaments.
What is shoulder impingement?
Shoulder impingement is where the rotator cuff tendons catch on or rub against the acromion (the top of the scapula where it connects to the collar bone). Impingement is the painful pinching of the tendons between the bones, when the arm is raised which makes overhead actions painful. It may occur when attempting to reach overhead for something; throwing during sports like baseball and tennis; reaching behind the back to zip up a dress; and sleeping on the stomach with arms out to the sides or above the head.
The pain can make every day activities painful and even cause sleep disturbances and alter range of motion.
What causes impingement?
Overuse is the most common cause. The overuse may result from an occupation, swimming and baseball. However, a narrow space beneath the acromion and arthritis can reduce the space in which the rotator cuff tendons function. A torn rotator cuff or labrum can also cause impingement. Bone spurs caused by friction or arthritis can narrow the acromion space causing impingement. An unstable shoulder can dislocate and cause impingement. Poor posture and age can contribute to development of shoulder impingement.
What are the symptoms?
• Pain with overhead activities
• decreased range of motion
• radiating pain from the shoulder into the side of the upper arm during overhead movements
• Intermittent pain that comes and goes
• pain at night
• a sensation of weakness in the shoulder
• swelling and tenderness
How is it diagnosed?
Your Ortho Illinois shoulder expert will review your medical history, ask about your symptoms and what causes your pain and conduct a physical exam. During the physical exam they will check your shoulder’s range of motion and compare it to your uninjured shoulder. They will look for symptoms of tenderness and swelling, and the use of specific orthopedic tests to trigger the pain. This will help them rule some causes of your pain, but they will order imaging tests including x-rays and an MRI to view the soft tissue to find inflammation, a torn cuff and other conditions that may be causing your pain or confirm impingement.
How is shoulder impingement treated?
Most often shoulder impingement is caused by overuse. The goal is to reduce inflammation, improve range of motion, strength and posture, to restore function and reduce pain. The first line treatment will be nonsurgical including rest, avoiding overhead activities and actions that cause pain; over the counter anti-inflammatory medications; and physical therapy. When indicated, corticosteroid injections can reduce inflammation and swelling. Corticosteroid injections can damage tendons so the patient may be limited to no more than 2 or 3 injections.
When nonsurgical treatments fail to improve your condition, your doctor may recommend
surgery. The types of surgery may include decompression surgery and rotator cuff repair. The procedure may be an open technique or an arthroscopic technique. Surgery will be followed by physical therapy to restore range of motion and strength. Most people can return to their daily activities 2-4 months after surgery, but full recovery can take a year.
