Shoulder impingement syndrome is the result of a vicious cycle of rubbing of the rotator cuff between your humerus and top outer edge of your shoulder. The rubbing leads to more swelling and further narrowing of the space, which result in pain and irritation. Treatments include rest, ice, anti-inflammatory medications, physical therapy, cortisone injections and surgery.
How does shoulder impingement syndrome develop?
When your rotator cuff is irritated or injured, it swells in much the same way your ankle does when it is sprained. However, because your rotator cuff is surrounded by bone, swelling causes other events to occur. Swelling reduces the amount of space around the rotator cuff, leading to rubbing against the acromion. Like a vicious cycle, the rubbing of the rotator cuff tendons result in swelling, which further narrows the space below the acromion. In some cases, bone spurs on the acromion bone can contribute to impingement by causing the space where the rotator cuff sits to be even more narrowed
What are the symptoms of shoulder impingement?
The first symptoms of impingement are mild. Therefore, many individuals do not seek treatment straight away. Symptoms gradually worsen over time. Initial symptoms include:
- Reduced range of movement
- Swelling/ inflammation
- Joint clicking
- Joint locking
In advanced cases, impingement may progress to a “frozen Shoulders .
How is shoulder impingement syndrome diagnosed?
Your healthcare provider will take your medical history and perform a physical examination to check for pain and tenderness. Your provider will also assess the range of motion of your shoulder and your arm/shoulder strength. They will ask if you are involved in repetitive activities that require overhead arm movement, what remedies you have tried to relieve your pain, prior injuries to the affected arm/shoulder and any details about what may have caused your shoulder pain and when it began.
X-rays are helpful to rule out arthritis and may show the rotator cuff injury. There may be bone spurs or changes in the normal outline of the bone where the rotator cuff normally attaches. Magnetic resonance imaging (MRI ) and ultrasound can show tears in the rotator cuff tendons and inflammation in the bursa.
A diagnosis of impingement syndrome may be made if a small amount of an anesthetic (painkiller), injected into the space under the acromion, relieves your pain.
Management and Treatment
The goal of treatment for shoulder impingement syndrome is to reduce your pain and restore shoulder function. Treatments for impingement syndrome include rest, ice, over-the-counter anti-inflammatory medications, injections and physical therapy.
- Physical therapy is the most important treatment for shoulder impingement syndrome. In most cases, you’ll only need one or two in-office visits to learn how to continue to do physical therapy on your own at home. You’ll learn stretching exercises to improve the range of motion of your shoulder. As your pain lessens, you can begin strengthening exercises to improve your rotator cuff muscles.
- Ice should be applied to the shoulder for 20 minutes once or twice a day. (A bag of frozen peas or corn also works well).
- If your healthcare provider approves, ibuprofen or naproxen may be taken as-needed to relieve pain. For more severe pain, a stronger prescription strength anti-inflammatory medication may be prescribe or a cortisone injection into the bursa beneath the acromion may be given.
- A common sense approach to activities is helpful. Avoid activities in which you need to frequently reach overhead or behind your back. These motions usually makes shoulders with impingement syndrome worse. Stop activities that involve these motions until your pain improves.
- Surgery is considered if nonsurgical treatments don’t relieve your pain. One surgery called a subacromial decompression or arthroscopic shoulder decompression removes part of the acromion to create more space for the rotator cuff. This procedure can be performed arthroscopically, which means through small cuts (incisions) in your shoulder. Other problems with your shoulder can be repaired at the time of surgery including arthritis in the shoulder, inflammation of the biceps tendon and partial rotator cuff tear. Open surgery, a surgery with a larger cut in the front of your shoulder, is another option.
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- Johns Hopkins Medicine