Background
Shoulder impingement syndrome is a condition characterized by pain during overhead movements. Impingement of the shoulder results from the pressure exerted on rotator cuff tendons by the acromion, a part of the scapula.
The rotator cuff tendons consist of muscles that serve as the connection between the scapula and the upper portion of the shoulder joint. When the rotator cuff tendons are injured, inflammation and swelling will occur subsequently compressing the tendons in between the bones in the shoulder joint. The compression causes friction between the rotator cuff tendons and the acromion.
Causes
Shoulder impingement is caused by repetitive arm lifts or overhead movements that are usually done by tennis or baseball athletes, construction workers, and lifters. Constantly raising the arms triggers the narrowing of space between the scapula and the rotator cuff tendons.
This causes friction, resulting to inflammation of the tendons. Injury to the tendon or bursa also will initially set off inflammation that causes swelling.
The formation of a person’s shoulder bones can also cause impingement syndrome as some are shaped with narrower space between the tendons and the acromion. An excessive calcium deposit on the rotator cuff tendons may also cause the narrowing of the space where the tendons pass through.
Additionally, there is also a high risk of shoulder impingement among individuals with deteriorating tendons because of old age, inflamed tissues and development of abnormal bones.
Signs and Symptoms
The most common sign of shoulder impingement is constant mild pain at rest and then intense pain and stiffness whenever overhead movements are performed. Gradual pain is also present when the raised arm is shifted to a lowered position.
Severe shoulder pain can also occur at night during sleep. When left untreated, individuals with shoulder impingement may exhibit grave symptoms such as loss of muscle movement and strength.
Diagnosis
In order to properly diagnose shoulder impingement, the physician initially reviews the patient medical history and complete physical examination. The physician will then make an assessment based on the exhibited signs and symptoms.
In some cases, the physician or the orthopedic will ask the patient to perform arm movements to identify the location and the degree of pain. Additionally, an impingement test involving injection of anesthetic into the space under the shoulder bones may also be performed. X-rays are ordered to determine if there is a presence of bone spurs.
An MRI is not required for the diagnosis of shoulder impingement but may be performed in order to rule out other serious conditions.
Treatment
The initial treatments of shoulder impingement are usually nonsurgical. These treatments include resting and refraining from activities that require overhead movements.
Movements such as reaching up or back, lifting, and throwing are to be avoided. As soon as the pain is minimized, proper stretching and strengthening exercises must also be incorporated as part of the treatment process in order to support the muscles and improve arm motions.
Oral anti-inflammatory medications may also be prescribed by the physician in order to lessen the pain and the inflammation. If inflammation persists, cortisone may be injected into the inflamed area to decrease inflammation. Cortisone should only be used when necessary as it weakens the muscles.
Surgery is not necessary but if nonsurgical treatments prove to be ineffective, an open surgical procedure involving the removal of some parts of the acromion may be done to allow more space for the rotator cuff to pass through.
