Shoulder Impingement

Shoulder impingement, also known as impingement syndrome, arises when the rotator cuff under the scapula (the upper external edge of the shoulder blade) is compressed or pinched. Impingement describes the pressing or rubbing of joint structures, and it frequently causes pain, particularly when moving.

The rotator cuff consists of a group of 4 muscles attaching the humerus (the upper arm bone) and the shoulder blade. These muscles are vital for overhead arm lifting and inward or outward rotation. The rotator cuff is more susceptible to pinching between these bones because of its modest location between the humerus and the acromion (the shoulder blade’s top region). This can result in shoulder impingement.

Symptoms

Pain is the primary symptom of shoulder impingement; it is usually felt in the front part of the shoulder. Other common signs include:

• Shoulder tenderness.
• Pain that radiates from the front of the shoulder towards the arm.
• Increased pain at night, often disturbing sleep.

The pain associated with shoulder impingement also tends to worsen with certain movements:

• Lifting the arm overhead.
• Raising or lowering the arm.
• Lying on the affected shoulder.
• Reaching behind the back.

Causes

Many shoulder impingement cases result from overuse; this is the reason it commonly affects athletes and sports enthusiasts. Overhead activities like painting or decorating can also irritate the bursa, leading to shoulder impingement.

If left untreated, persistent impingement can cause thickening of the acromion bone and damage to the rotator cuff, potentially resulting in rotator cuff tears.

Other factors that may contribute to shoulder impingement involve:

• Bursitis: Inflammation or irritation of the fluid-filled sac (bursa) between the acromion and the rotator cuff tendon, often due to shoulder overuse or injury.
• Curved or hooked acromion: A congenital condition where the acromion has an abnormal shape instead of being flat.
• Bony spurs on the acromion: These growths can develop over time, often due to aging, though they can also occur at any stage.

Risk Factors

Shoulder impingement can affect everyone; but it is more prevalent among athletes and those with jobs that involve repeated shoulder movements. Sports activities likely to increase the risk of shoulder impingement are:

• Swimming
• Volleyball
• Baseball
• Tennis

Occupations that require physical labor, like construction, window cleaning, painting, and drywall or wallpaper installation, can also elevate the risk of developing shoulder impingement.

Diagnosis

During the shoulder impingement diagnosis, we will begin by discussing your medical history, symptoms, past injuries, and workout routine. We will then perform a physical examination, guiding you through a series of shoulder movements to help identify the issue and rule out other potential conditions.

We may recommend imaging tests, such as X-ray, ultrasound or 3T MRI, to gain a clearer view of the shoulder as well as make a precise diagnosis.

Treatment Options

Our specialists at The Joint Pain Clinic will create a personalized treatment plan tailored to your specific needs. Depending on the severity of your shoulder impingement, they may suggest resting, exercises or anti-inflammatory pain relievers.

Other treatment options include:

Physiotherapy

This approach helps alleviate pain and enhance your range of motion. Initially, you may need to perform exercises under the guidance of your physiotherapist, but eventually, you should be able to continue them on your own at home.

With proper care and consistent shoulder exercises, most cases of shoulder impingement get better within a few weeks or months.

Steroid injections

Steroid injections (cortisone) may be administered if other options are ineffective. For some, this treatment may completely alleviate pain, eliminating the need for further intervention. In other cases, it may provide temporary relief, lasting just a few weeks, and multiple courses may be given in combination with exercises. If steroid injections fail to work, your provider will explore other treatment options with you.

Surgery

Sometimes, a keyhole procedure known as a subacromial decompression, done with or without a rotator cuff repair, can be recommended. This surgery aims to create more room around the rotator cuff tendon, preventing it from rubbing or catching on the acromion.

Prevention

To minimize the risk of shoulder impingement, consider the following:

• Avoiding overloading the shoulders, particularly during workouts or physical activities.
• Always warming up and cooling down appropriately before participating in sports.
• Using the proper equipment for both sports and work-related tasks.
• Seeking medical advice as soon as you experience shoulder pain or discomfort.

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