Shoulder Impingement
Shoulder Impingement is one of the most common causes of pain in the adult shoulder. It results from pressure on the rotator cuff from part of the shoulder blade (scapula) as the arm is lifted.
The rotator cuff is a tendon linking four muscles - the supraspinatus, the infraspinatus, the subscapularis, and the teres minor. These muscles cover the "ball" of the shoulder (head of the humerus). The muscles work together to lift and rotate the shoulder.
The acromion is the front edge of the shoulder blade. It sits over and in front of the humeral head. As the arm is lifted, the acromion rubs or "impinges" on the surface of the rotator cuff. This causes pain and limits movement. The pain may be due to a "bursitis" or inflammation of the bursa overlying the rotator cuff or a "tendonitis" of the cuff itself. In some patients, a partial tear of the rotator cuff may cause impingement pain.
Risk Factors/Prevention
Shoulder Impingement is common in both young athletes and middle-aged people. Young athletes who use their arms overhead for swimming, baseball and tennis are more vulnerable. Those who do repetitive lifting or overhead activities using the arm such as paper hanging, construction, window washer, painting are also susceptible. Pain may also develop as the result of minor trauma or accident.
Symptoms
Beginning symptoms may be mild. Patients frequently do not seek treatment at an early stage.
- You may first be aware of minor pain that's present both with activity and at rest.
- You may have pain radiating from the front of the shoulder to the side of the arm.
- You may note sudden pain with lifting and reaching movement.
- Athletes in overhead sports may have pain when throwing or serving a tennis ball.
Other symptoms of Shoulder Impingement:
- Local swelling
- Tenderness in the front of the shoulder
- Pain and stiffness when you try to lift your arm
- Pain when you try to lower your arm from an elevated position
- Pain at night
- Loss of shoulder strength and motion
- Having difficulty with activities that place the arm behind the back, such as buttoning or zippering
- Loss of Motion in shoulder may lead to a “frozen shoulder”
- Acute Bursitis patients also have severely tender shoulders and all movements are limited and painful
Diagnosis
To diagnose shoulder impingement, an orthopaedic surgeon reviews the symptoms and physically examines the shoulder.
- X-rays will show if there is a bone spur
- MRI to see if fluid or inflammation is in the bursa and rotator cuff or to identify if there is a rotator cuff tear
- An impingement test, injection of local anesthetic into the bursa, can help to confirm the diagnosis.
Treatment Options : Non-Surgical
Initial treatment is usually conservative.
- Proper rest
- Avoiding overhead activities
- Oral non-steroidal anti-inflammatory medications can be prescribed, e.g. Ibuprofen, Naproxen
- Stretching exercises to improve range of motion in a stiff shoulder will also help.
- Corticosteroid injection into the affect area with a local anesthetic provides good relief to many patients
- Physical Therapy
Treatment Options: Surgical
When conservative treatment does not relieve pain, the doctor may recommend surgery. The goal of surgery is to remove the impingement and create more space for the rotator cuff. This allows the humeral head to move freely in the subacromial space and to lift the arm without pain. The most common surgical treatment is subacromial decompression or anterior acromioplasty. This may be performed by either arthroscopic or open techniques:
Minimally Invasive Arthroscopic Shoulder Surgery: Only two or three small puncture wounds are made. The joint is examined through a fiberoptic scope connected to a television camera. Small instruments are used to remove bone and soft tissue.
Rehabilitation
After surgery, the arm may be placed in a sling for a short period of time. This allows for early healing. As soon as you are comfortable, you may remove the sling and begin exercise and use of the arm. Your orthopedic surgeon will provide a rehabilitation program that is based on your specific needs and the findings at surgery. These will include exercises to regain range of motion of the shoulder and strength of the arm. It may take two to four months to achieve complete relief of pain.
