Shoulder Impingement Syndrome

Reviewed on 12/9/2022

Shoulder Impingement Syndrome
Shoulder impingement is a disorder that produces shoulder discomfort and limits the range of motion.

Impingement syndrome or shoulder impingement syndrome is a common condition that causes pain and discomfort in the shoulder. Impacted tendons or bursae in the rotator cuff of the shoulder manifest this condition. They rub against the head of the humerus bone and acromion bone (the top outer edge of the shoulder blade) continuously.

The risk of impingement syndrome increases with repeated overhead activities, such as:

Bone and joint disorders are other risk factors. Pain from impingement syndrome is chronic and interferes with daily activities.

Impingement syndrome can cause tendinitis and bursitis (inflammation of the tendons in the rotator cuff and bursa) over time. The rotator cuff tendons can become thin and tear if not properly treated. Impingement syndrome accounts for 44 to 65 percent of all shoulder pains.

What are the causes and risk factors of impingement syndrome?

Shoulder impingement is a disorder that produces shoulder discomfort and limits the range of motion. Shoulder impingement can affect anybody, but people who have specific risk factors are more prone to acquiring it.

  • Overuse of the arms and shoulders, especially repeated heavy lifting
  • Curved or hooked acromion (upper part of the shoulder blade bone, which is usually flat)
  • Prominent coracoid (a small projection of the shoulder blade)
  • Shoulder instability causing frequent dislocations
  • History of shoulder injuries
  • Bone spurs (extra projections from the bone, which occupy space and impair the free movement of the tendons and muscles)
  • Coracoacromial ligament calcification
  • Poor posture, such as humping
  • Age older than 50 years

What are the symptoms of impingement syndrome?

The most common sign of shoulder impingement is sharp discomfort in the shoulder when you move your arm overhead or backward.

Other signs and symptoms include:

  • Mild but persistent arm discomfort with both activity and at rest
  • Radiating pain from the shoulder to the arm
  • Pain that worsens at night
  • Shoulder or arm weakness
  • Pain with lifting arms, especially to reach things
  • Athletes participating in overhead sports may experience discomfort
  • Pain with daily activities, such as placing the arm behind the back or buttoning
  • Reduced range of motion and strength of the arm

How is impingement syndrome diagnosed?

A thorough history and physical exam are sufficient to diagnose shoulder impingement syndrome. People with impingement typically report shoulder discomfort that worsens with overhead activity and is severe enough to wake them up in the middle of the night.

Your doctor may perform specialized shoulder manipulation to validate the diagnosis. They may order:

  • Radiological imaging
    • Shoulder X-rays: To determine the existence of bone spurs and/or constriction of the subacromial space.
  • MRI
    • Provides visualization of the rotator cuff.
    • To rule out more serious diseases.

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What are the treatment options for impingement syndrome?

Eliminating any known cause or contributing factor is the first step to treating shoulder impingement. This may imply temporarily refraining from sports, such as tennis, pitching, or swimming.

  • Nonsteroidal anti-inflammatory drugs: Ibuprofen, aspirin, and naproxen reduce pain and swelling.
  • Physical therapy:
    • Involves exercises to restore normal shoulder girdle flexibility and strength. The rotator cuff muscles and the muscles responsible for proper shoulder blade movement are strengthened.
    • The doctor, licensed sports trainer, or experienced physical therapist will first work to restore normal shoulder mobility. Stretching activities increase the range of motion. Stretching the posterior capsule can effectively reduce shoulder discomfort.
  • Steroid injections: If rest, drugs, and physical therapy do not reduce your pain, a local anesthetic and cortisone injection could be beneficial. Cortisone is a powerful anti-inflammatory medication. It can be injected into the bursa beneath the acromion to ease discomfort.
  • Surgery:
    • Not required in most cases of shoulder impingement syndrome. However, surgical intervention could be beneficial if symptoms continue despite sufficient nonsurgical therapy.
    • Debridement or surgical removal of tissue that is aggravating the rotator cuff is done. Uses either open or arthroscopic procedures. The outcome is good in about 90 percent of cases.
  • Rehabilitation:
    • Following surgery, your arm could be put in a sling for a brief time. This enables quicker recovery. As soon as you are comfortable, your doctor will remove the sling and encourage you to begin exercising and using your arm.
    • Your doctor will design a rehabilitation regimen for you depending on your needs and the results of the surgery. This will involve workouts to regain shoulder range of motion and arm strength. Complete pain relief usually takes two to four months, but it might take up to a year.

How to prevent impingement syndrome

Be aware of the things you do regularly that may put you in danger.

  • Avoid straining your shoulder by keeping them in awkward positions for extended periods.
  • If the condition is work-related or induced by work, get your workstation examined for occupational dangers.
  • Rest, ice, and a good mobility health program can help you control inflammation
  • Everyone, especially older adults, must follow caution and gradually increase the intensity of workouts over time
  • Quit smoking

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References
Image Source: iStock image

Shoulder Impingement Syndrome. https://www.ucsfhealth.org/conditions/shoulder-impingement-syndrome

Shoulder Impingement Syndrome. https://my.clevelandclinic.org/health/diseases/7079-shoulder-impingement-syndrome Impingement

Syndrome of the Shoulder. https://www.cedars-sinai.org/health-library/diseases-and-conditions/i/impingement-syndrome-of-the-shoulder.html

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