Impingement Syndrome

Shoulder Impingement syndrome is the result of a vicious cycle of rubbing of the rotator cuff between your humerus and top outer edge of your shoulder. The rubbing leads to more swelling and further narrowing of the space, which result in pain and irritation. Treatments include rest, ice, anti-inflammatory medications, physical therapy, cortisone injections and surgery.

Shoulder Impingement syndrome occurs when the top outer edge of your shoulder blade, called the acromion, rubs against (“impinges on”) or pinches your rotator cuff beneath it, causing pain and irritation.

When your rotator cuff is irritated or injured, it swells in much the same way your ankle does when it is sprained. However, because your rotator cuff is surrounded by bone, swelling causes other events to occur. Swelling reduces the amount of space around the rotator cuff, leading to rubbing against the acromion. Like a vicious cycle, the rubbing of the rotator cuff tendons result in swelling, which further narrows the space below the acromion. In some cases, bone spurs on the acromion bone can contribute to impingement by causing the space where the rotator cuff sits to be even more narrowed.

Shoulder impingement syndrome is most commonly seen in individuals who are involved in sports and other activities with a lot of overhead rotational motion – like swimming, baseball, volleyball and tennis as well as things such as window washing and painting.

Shoulder impingement can also result from an injury, such as a fall onto an outstretched arm or directly onto the shoulder.

Causes of Impingement Syndrome

Your rotator cuff tendon passes through a space below the acromion. The acromion is the bony tip of the outer edge of your shoulder blade (scapula) that comes off the top of the back side of this bone. It meets with the end of your collar bone (clavicle) at your shoulder. Shoulder impingement occurs when the tendon rubs against the acromion.

The causes of this impingement include:

• Your tendon is torn or swollen. This can be due to overuse from repetitive activity of the shoulder, injury or from age-related wear and tear.
• Your bursa is irritated and inflamed. Your bursa is the fluid-filled sac between your tendon and the acromion. Your bursa helps your muscles and tendons glide over your bones. Your bursa can become inflamed due to overuse of the shoulder or injury.
• Your acromion is not flat (you were born this way) or you have developed age-related bone spurs on your acromion.

Symptoms of shoulder impingement syndrome include:

• Pain when your arms are extended above your head.
• Pain when lifting your arm, lowering your arm from a raised position or when reaching.
• Pain and tenderness in the front of your shoulder.
• Pain that moves from the front of your shoulder to the side of your arm.
• Pain when lying on the affected side.
• Pain or achiness at night, which affects your ability to sleep.
• Pain when reaching behind your back, like reaching into a back pocket or zipping up a zipper.
• Shoulder and/or arm weakness and stiffness.

Symptoms usually develop gradually over weeks to months.

Shoulder impingement is closely related to other common sources of pain in the shoulder called bursitis and rotator cuff tendonitis. These conditions can occur alone or in combination. Shoulder pain can also be a sign of a more serious injury to your rotator cuff, a small tear or hole called a rotator cuff tear. If your rotator cuff has torn completely, you’ll likely have significant weakness and may not be able to raise your arm against gravity. In addition, you may have a rupture (tear) of your biceps muscle tendon as part of this continuing impingement process.

Diagnosis

Orthopedic Specialist at Shreya Hospital, Ghaziabad will take your medical history and perform a physical examination to check for pain and tenderness. Your provider will also assess the range of motion of your shoulder and your arm/shoulder strength. They will ask if you are involved in repetitive activities that require overhead arm movement, what remedies you have tried to relieve your pain, prior injuries to the affected arm/shoulder and any details about what may have caused your shoulder pain and when it began.

Might require some imaging tests like:

• X-Ray
• MRI
• Ultrasound

Treatment

The goal of treatment for shoulder impingement syndrome is to reduce your pain and restore shoulder function. Treatments for impingement syndrome include rest, ice, over-the-counter anti-inflammatory medications, steroid injections and physical therapy.

• Physical therapy is the most important treatment for shoulder impingement syndrome. In most cases, you’ll only need one or two in-office visits to learn how to continue to do physical therapy on your own at home. You’ll learn stretching exercises to improve the range of motion of your shoulder. As your pain lessens, you can begin strengthening exercises to improve your rotator cuff muscles.
• Ice should be applied to the shoulder for 20 minutes once or twice a day. (A bag of frozen peas or corn also works well).
• If your healthcare provider approves, ibuprofen or naproxen may be taken as-needed to relieve pain. For more severe pain, a stronger prescription strength anti-inflammatory medication may be prescribe or a cortisone injection into the bursa beneath the acromion may be given.
• A common sense approach to activities is helpful. Avoid activities in which you need to frequently reach overhead or behind your back. These motions usually makes shoulders with impingement syndrome worse. Stop activities that involve these motions until your pain improves.

Surgery

Surgery is considered by Orthopedic Surgeon at Shreya Hospital, if nonsurgical treatments don’t relieve your pain. One surgery called a subacromial decompression or arthroscopic shoulder decompression removes part of the acromion to create more space for the rotator cuff. This procedure can be performed arthroscopically, which means through small cuts (incisions) in your shoulder. Other problems with your shoulder can be repaired at the time of surgery including arthritis in the shoulder, inflammation of the biceps tendon and partial rotator cuff tear. Open surgery, a surgery with a larger cut in the front of your shoulder, is another option.