Think You Might Have
Shoulder Impingement?

Shoulder impingement syndrome is a common source of shoulder joint pain. What is impingement syndrome? What are the best treatments for this type of shoulder injury? And finally, is surgery ever necessary?



Shoulder Anatomy

The shoulder is comprised of three bones: the humerus, scapula, and clavicle. The ball and socket configuration of the shoulder joint is comprised of the head of the humerus as it connects to the socket or glenoid of the scapula. Shoulder Anatomy

The shoulder is a very mobile joint with a majority of the stability of the joint provided by the rotator cuff muscles. Stability is also provided by another structure called the joint capsule. Together the cuff muscles and capsule function to keep the head of the shoulder in the socket.

The shoulder also contains a number of bursae. A bursa is a fluid filled sac that functions to cushion bony prominences. The largest bursa of the shoulder is called the subacromial bursa.


What Is Shoulder Impingement?

Impingement syndrome is one of a number of shoulder conditions associated with the soft tissue of the shoulder. Impingement is the mechanical pinching of the soft tissue between the head of the humerus and the subacromial arch.

The structures that can become impinged include both the subacromial bursa and the supraspinatus tendon. For this reason, impingement syndrome is often associated with shoulder bursitis or shoulder tendonitis. When these structures become impinged inflammation is created leading to shoulder pain.


What Causes Impingement Syndrome?

Impingement syndrome can be caused by a number of factors including bone spurs, capsular tightness, and/or rotator cuff weakness.

Bone spurs are frequently associated with the development of shoulder impingement. Bone spurs form on the bottom of the acromion and begin to narrow the subacromial space making it easier for structures to become impinged. These bone spurs are often referred to as hooks of the acromion and are rated as first, second, or third degree. The larger the hook the more likely the supraspinatus and/or bursa will get pinched.


Hook of the acromion



Joint capsule tightness can also play a role in the development of impingement syndrome. When the capsule becomes tight the shoulder moves in an abnormal fashion. Most commonly the inferior or bottom of the capsule will tighten, causing the head of the shoulder to rise up into the subacromial space. This in turn narrows the space and causes the bursa and supraspinatus tendon to become pinched. An extreme form of this capsular tightness is called adhesive capsulitis.

Finally, rotator cuff weakness can also play a role in the development of impingement syndrome. If the rotator cuff becomes weak, the shoulder becomes less stable. This lack of stability will allow the head of the humerus to elevate into the subacromial space.



Signs and Symptoms

Typically if you have shoulder impingement, symptoms will include shoulder pain, specifically with any movement overhead or across your body, and occasionally shoulder stiffness. Functional activities such as putting on a shirt or washing your hair can be painful.

Diagnosis of impingement syndrome is typically made after a thorough history, physical exam to assess shoulder mobility and strength, and x-rays. X-rays are utilized to determine if any bone spurs are present, the shape of the acromion, and the extent of the narrowing of the subacromial space.


Typical Treatment

Like other shoulder issues, treatment of impingement syndrome begins by reducing inflammation. Utilizing ice therapy is an easy and effective way of minimizing tissue inflammation. Apply ice to the shoulder, 10 minutes at a time a few times a day.

shoulder mobilizations

Other means of reducing inflammation include anti-inflammatory medication (consult your doctor regarding medication) and in some cases cortisone injections.

Physical therapy can also be utilized to help minimize shoulder inflammation. Modalities including phonophoresis, iontophoresis, and interferential stimulation can also be used to help reduce soft tissue inflammation.

For restoring normal shoulder mobility, physical therapy should be included to minimize capsular tightness. Manual joint mobilization and capsular stretching are utilized to help restore normal shoulder capsule mobility.


Surgery

The typical conservative treatment of ice, anti-inflammatory medication, physical therapy, and cortisone injection is very effective in reducing shoulder joint pain and restoring normal shoulder mobility and function. Most symptoms resolve within 6-8 weeks with significant symptoms taking as long as 4 months.

shoulder surgery


Only when a course of conservative treatment of at least six months has failed should surgery be considered. Most often surgery is required in associated with the presence of a bone spur. The most common type of surgery performed for this condition is called a subacromial decompression. This arthroscopic procedure involves removing the bone spur to allow for more room in the subacromial space. Recovery from this surgery can take up to three months and involves physical therapy to help restore normal range of motion, strength, and function.

Shoulder impingement is common shoulder injury that responds to conservative treatment. Follow the treatment recommendations on a consistent basis and your shoulder pain will resolve in no time.



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