Shoulder impingement occurs when the top edge of your shoulder blade, called the acromion, rubs against your rotator cuff beneath it, causing pain, swelling and irritation. The rotator cuff is a group of four muscles that originate from the shoulder blade and attach to your arm bone or humerus. The rotator cuff muscles help raise the arm overhead, as well as rotate the arm towards and away from the body. The cuff muscles sit in a small space between the acromion and the humeral head and that makes them susceptible to being pinched, leading to the so-called impingement syndrome.
Impingement syndrome occurs when the cuff tendons rub against the acromion.
Some causes of impingement syndrome include:
• Sport activities with overhead repetitive rotational motion, such as swimming, baseball, volleyball and tennis
• Some professions with repetitive overhead motion (painters, window cleaners)
• Bone spurs have developed in the acromion (might be age-related)
• The acromion is not flat as usual, but curved (may run in the family)
What are the symptoms of impingement syndrome?
Symptoms usually develop gradually over weeks or months. The symptoms of impingement syndrome may include:
• Pain when lifting your arm overhead to reach something (i.e., from the cupboard)
• Pain in the front and side of your shoulder
• Pain when lying on the affected side
• Pain a night that may affect sleep
• Pain when reaching behind your back (i.e., to your back pocket)
Dr Panagopoulos will take a complete history and perform a focused physical exam, including assessing your shoulder range of motion and shoulder functional tests. An x-ray will help rule-out arthritis of the shoulder. There may also be bone spurs or a change in the outline of bone on the rotator cuff insertion (enthesitis). An MRI scan will demonstrate inflammation of the bursa or rotator cuff tears.
As with most shoulder pathology, a trial of conservative management is attempted first. Conservative management may include:
• Rest
• Ice – you may apply an ice pack or pack of frozen beans for 20’ once or twice a day. Use a cloth to avoid burning the skin
• NSAIDs (for a short course only)
• Physical therapy - deltoid & cuff strengthening can definitely help to improve your pain
• Steroid injections – you may have 1 or 2 injections in the subacromial space. Success rate is about 70%. Steroid may cause some flare-up pain for 24-48 hours before kicking in. More than 2 injections may weaken the tendon and should be avoided.
If conservative treatment fails, keyhole surgery can be offered. Surgery can be performed arthroscopically. The procedure is called subacromial decompression or acromioplasty and involves shaving-contouring your acromion to increase the space available underneath for your rotator cuff. Other shoulder problems, such as biceps tendon problems or partial cuff tears can be diagnosed and treated during the procedure. This is a day case, and you can go home a few hours after the procedure if you wish. If no cuff tear is found during the procedure, your arm will be placed in a sling for a few days for comfort, and you can start physiotherapy right away.
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