Shoulder Impingement Syndrome

by / Sunday, 10 March 2019 / Published in Orthopedic, shoulder instability, Shoulder Surgery

Shoulder impingement syndrome is a condition in which the supraspinatus tendon at the top rotator cuff and bursa get impinged between the humerus and the acromion process of the scapula. It is characterized by pain at the front and/or outside of the shoulder and upper arm, which tends to be worse at night when sleeping on the affected side, or when lifting or elevating the arm (the painful arc).

The underlying cause is the insufficient room between the acromion and the rotator cuff causing impingement. Normally, the rotator cuff tendons can easily slide under the acromion each time your arm is raised, but there can be a greater degree of rubbing or pinching of the tendons and bursa in some individuals, especially if there is overuse of the shoulder in an elevated position. This causes pain and if ignored can cause damage to the rotator cuff tendons. Bony spurs on the undersurface of the acromion can also contribute to this impingement syndrome. Other contributing factors include poor posture and tight anterior chest wall muscles. The biggest risk factor for developing shoulder impingement syndrome is playing sports that require using your shoulders for overhead as a forceful motion, such as seen in swimming, tennis, baseball and other similar sports. Also, occupations that require lots of heavy lifting or arm movement also increase the risk, including construction work, moving boxes, painting, etc. Older age and prior shoulder injuries, such as a dislocation, also increase the risk of shoulder impingement.

The biggest risk factor for developing shoulder impingement syndrome is playing sports that require using your shoulders for overhead as a forceful motion

It is a clinical diagnosis, based on a proper history and a focused exam; the latter involves a series of tests that involve motions using one’s shoulder while they check for any unusual movement. In some cases, an X-ray is performed to rule out arthritis or check for bone spurs that can cause impingement. An MRI can be performed if there is a concern for a rotator cuff injury or if the diagnosis is unconfirmed.

 

The management typically includes rest from the aggravating activities, ice, anti-inflammatory medicines, and physical therapy. Improving one’s posture can be very helpful as well. Corticosteroid injections or surgery may be needed in severe cases refractory to the said management. The goal of the surgery is to widen the space around your rotator cuff so that the tendons may move freely without catching or rubbing on your bone. This can be typically achieved by minimally invasive arthroscopic surgery, but more severe cases may need open surgery. If the impingement has led to the rotator cuff tear, then surgery is inevitable. After the surgery, the patient has to briefly wear an arm sling, and it usually takes anywhere between three to six months to heal completely, with more severe cases taking up to a year to full recovery. During this time, the activity needs to be limited, and physical therapy exercises need to be carefully performed.

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