Shoulder Impingement​

Shoulder impingement, also known as subacromial impingement syndrome, is a condition where the tendons of the rotator cuff or the bursa (a fluid-filled sac that reduces friction between tissues) become compressed or “impinged” between the bones of the shoulder. This compression occurs in the subacromial space, the area beneath the acromion (the top part of the shoulder blade).

Causes

Shoulder impingement can develop from a variety of causes, including:

• Repetitive overhead activities: Activities or sports that involve frequent overhead motions, such as swimming, tennis, or painting, can lead to irritation and inflammation of the rotator cuff tendons.
• Muscle imbalances: Weakness or imbalances in the shoulder muscles can cause the humeral head (upper arm bone) to move improperly, leading to impingement.
• Bone spurs: Bony growths on the underside of the acromion can narrow the subacromial space and increase the risk of impingement.
• Postural issues: Poor posture, such as slouching or rounded shoulders, can alter the position of the shoulder blade, leading to impingement.
• Age-related wear and tear: As people age, the rotator cuff tendons and the bursa can become more prone to inflammation and injury, increasing the risk of impingement.

Symptoms

The symptoms of shoulder impingement often develop gradually and may include:

• Pain: A dull ache in the shoulder, particularly when lifting the arm overhead, reaching behind the back, or lying on the affected side.
• Weakness: Reduced strength in the shoulder, making it difficult to lift objects or perform certain movements.
• Stiffness: Limited range of motion in the shoulder, especially when trying to reach overhead or out to the side.
• Pain at night: Discomfort that worsens at night, often disrupting sleep.
• Tenderness: Sensitivity or tenderness when pressing on the front or side of the shoulder.

Diagnosis

Diagnosing shoulder impingement typically involves:

• Medical history and physical examination: A healthcare provider will ask about symptoms, activity level, and any history of shoulder injuries. They may perform specific tests, such as the Neer and Hawkins-Kennedy tests, to assess pain and range of motion.
• Imaging: X-rays can help identify bone spurs or other structural issues, while an MRI or ultrasound may be used to visualize soft tissue damage, such as rotator cuff tears or bursitis.

Treatment

Treatment for shoulder impingement aims to reduce pain, improve function, and prevent further injury:

• Non-surgical treatment:
  • Rest and activity modification: Avoiding activities that exacerbate symptoms, particularly overhead movements, can help reduce irritation.
  • Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help reduce pain and inflammation.
  • Physical therapy: A physical therapist can guide exercises to strengthen the shoulder muscles, improve flexibility, and correct posture to alleviate impingement.
  • Corticosteroid injections: In cases of severe pain or persistent symptoms, a corticosteroid injection into the subacromial space may provide temporary relief by reducing inflammation.
• Surgical treatment:
  • Arthroscopic surgery: If non-surgical treatments are ineffective, arthroscopic surgery may be recommended. This minimally invasive procedure involves removing bone spurs, releasing the coracoacromial ligament, or addressing any rotator cuff damage to increase the subacromial space and reduce impingement.

Recovery

Recovery from shoulder impingement depends on the severity of the condition and the treatment approach:

• Non-surgical recovery: With appropriate rest, physical therapy, and activity modifications, many people experience significant improvement within a few weeks to a few months.
• Post-surgical recovery: If surgery is required, recovery may take several months, with a focus on rehabilitation exercises to restore strength and range of motion.

Prevention

Preventing shoulder impingement involves maintaining good shoulder health through:

• Proper exercise technique: Ensuring correct form during activities and exercises, particularly those involving overhead motions.
• Regular stretching and strengthening: Focusing on exercises that improve shoulder flexibility and strengthen the rotator cuff and scapular muscles.
• Maintaining good posture: Keeping the shoulders back and avoiding slouching can help prevent impingement.
• Listening to your body: Avoiding overuse and allowing adequate rest between activities to prevent irritation.

In summary, shoulder impingement is a common condition caused by the compression of the rotator cuff tendons or bursa in the shoulder. With early diagnosis and appropriate treatment, including rest, physical therapy, and possibly surgery, most individuals can recover and return to their regular activities.