Shoulder Impingement Syndrome

 Shoulder impingement syndrome is caused by the rotator cuff pressing on the humerus and the top outer border of your shoulder in a vicious cycle. The rubbing causes swelling and a constriction of the area, resulting in pain and irritation. Rest, ice, anti-inflammatory medicines, physical therapy, cortisone injections, and surgery are all options for treatment.

Shoulder Impingement Syndrome

What is shoulder impingement syndrome, and how does it affect you?

Shoulder impingement happens when the acromion, the upper outer edge of your shoulder blade, pushes on or pinches the rotator cuff beneath it, causing pain and irritation.

What is the function of my rotator cuff?

The rotator cuff is a set of four muscles that start on the shoulder blade and attach as a "cuff" of tendon to your arm bone, as seen in the figure (humerus).

Your rotator cuff assists you in raising your arm overhead and rotating it towards and away from your body. The rotator cuff resides in a narrow gap between two bones of the shoulder, as seen in the picture (the acromion and the humerus). Because of this arrangement, the rotator cuff can be constricted or "impeded" between these bones, resulting in "impingement syndrome."

What causes shoulder impingement syndrome?

When the rotator cuff is inflamed or injured, it expands in the same manner as a sprained ankle does. However, because your rotator cuff is bordered by bone, swelling triggers a cascade of events. Because swelling reduces the amount of space around the rotator cuff, the acromion rubs on it. The friction of the rotator cuff tendons causes swelling, which further narrows the space behind the acromion, like a vicious cycle. Bone spurs on the acromion bone, in some situations, can lead to impingement by narrowing the space where the rotator cuff resides.

The rotator cuff is a set of muscles that sit between the acromion and the humerus in the tiny area between them.

Who is afflicted with shoulder impingement?

Shoulder impingement syndrome is particularly common in those who participate in sports or other activities that require a lot of overhead rotational motion, such as swimming, baseball, volleyball, and tennis, as well as window washing and painting.

Injury to the shoulder, such as a fall onto an outstretched arm or directly onto the shoulder, can cause impingement.

What is the prevalence of shoulder impingement?

Shoulder impingement syndrome is estimated to be the cause of 44 percent to 65 percent of all complaints of shoulder pain.

What causes impingement in the shoulder?

The tendon of your rotator cuff goes through a gap beneath the acromion. The acromion is the bony tip of your shoulder blade's (scapula) outside edge that protrudes from the top of the back side of this bone. At the shoulder, it connects with the end of your collar bone (clavicle). When the tendon rubs against the acromion, shoulder impingement ensues.

The following are some of the factors that contribute to the impingement:

• Your tendon is swelled or torn. This can be caused by overuse through repetitive shoulder activities, injury, or age-related wear and strain.

• The bursa in your shoulder is irritated and inflamed. The fluid-filled sac between your tendon and the acromion is your bursa. Your bursa aids in the smooth gliding of your muscles and tendons over your bones. Overuse of the shoulder or injury can cause the bursa to become inflamed.

• You have age-related bone spurs on your acromion or your acromion is not flat (you were born this way).

What are the signs and symptoms of shoulder impingement?

The following are some of the signs and symptoms of shoulder impingement syndrome:

• When your arms are extended above your head, it causes pain.

• When elevating your arm, lowering your arm from an elevated posture, or reaching, you may experience pain.

• Tenderness and pain in the front of your shoulder.

• Pain that radiates from your front shoulder to your arm's side.

• When laying on the affected side, there is pain.

• At night, you may experience pain or achiness, which may interfere with your ability to sleep.

• Reaching behind your back, such as into a back pocket or zipping up a zipper, causes pain.

• Weakness and stiffness in the shoulders and/or arms.

Symptoms usually appear over a period of weeks to months.

Shoulder impingement is linked to bursitis and rotator cuff tendonitis, two other major causes of shoulder pain. These situations can arise singly or in groups. Shoulder pain could indicate a more serious rotator cuff damage, such as a small tear or hole called a rotator cuff tear. If your rotator cuff is fully ripped, you'll probably feel a lot of pain and won't be able to elevate your arm against gravity. Additionally, as part of the ongoing impingement process, your biceps muscle tendon may rupture (tear).

How can you know if you have shoulder impingement syndrome?

Your medical history will be taken, and a physical examination will be performed to check for discomfort and soreness. Your provider will also evaluate your shoulder's range of motion and arm/shoulder strength. They'll want to know if you do any repeated occupations that demand overhead arm movement, what treatments you've attempted to reduce your discomfort, if you've had any previous injuries to the afflicted arm/shoulder, and any specifics about what caused your shoulder pain and when it started.

X-rays can help rule out arthritis while also revealing a rotator cuff damage. Bone spurs or alterations in the typical contour of the bone where the rotator cuff connects are possible. Tears in the rotator cuff tendons and inflammation in the bursa can be seen on magnetic resonance imaging (MRI) and ultrasound.

If a small dose of anesthetic (painkiller) injected into the space under the acromion helps your pain, you may have impingement syndrome.

What is the treatment for shoulder impingement syndrome?

The purpose of shoulder impingement syndrome treatment is to alleviate pain and restore shoulder function. Rest, ice, over-the-counter anti-inflammatory medicines, steroid injections, and physical therapy are all options for treating impingement syndrome.

• The most significant treatment for shoulder impingement syndrome is physical therapy. In most circumstances, you'll only need one or two clinic visits to learn how to practice physical therapy at home on your own. Stretching exercises will be taught to help you enhance your shoulder's range of motion. You can begin strengthening activities to improve your rotator cuff muscles when your pain subsides.

• Once or twice a day, ice should be applied to the shoulder for 20 minutes. (A bag of frozen peas or corn will also suffice.)

• Ibuprofen or naproxen can be taken as needed to treat pain if your healthcare provider authorizes. A heavier prescription level anti-inflammatory medicine or a cortisone injection into the bursa beneath the acromion may be prescribed for more severe discomfort.

• It is beneficial to approach things with common sense. Avoid tasks that require you to reach overhead or behind your back regularly. These motions aggravate impingement syndrome in the shoulders. Stop doing things that require these motions until your pain goes away.

Surgery

If nonsurgical therapy fail to relieve your discomfort, surgery may be considered. A subacromial decompression, also known as arthroscopic shoulder decompression, involves removing a portion of the acromion to make room for the rotator cuff. This operation is done arthroscopically, which means it is done through small cuts (incisions) in your shoulder. Arthritis in the shoulder, inflammation of the biceps tendon, and a partial rotator cuff tear are all disorders that can be addressed during surgery. Another alternative is open surgery, which involves a wider cut in the front of your shoulder.

If I have shoulder impingement, what may I expect as a result (prognosis)?

Your shoulder may improve in a few weeks or months if you stick to your treatment plan of rest, ice, anti-inflammatory drugs, physical therapy, and cortisone injections. Within two years, over 60% of persons who follow these conservative therapy report satisfactory results.

If nonsurgical therapy fail to relieve your pain, surgery may be indicated.

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