Shoulder Impingement Syndrome

Shoulder impingement is one of the most common reason adults have shoulder pain. It occurs when certain structures of the shoulder–particularly the soft tissues of the rotator cuff and the lubricating sack (subacromial bursa) between the rotator cuff and the underside of the bone that is the top part of the shoulder (acromion)–within the shoulder are irritated or “pinched.” When it becomes a chronic condition, a patient is diagnosed with shoulder impingement syndrome. This syndrome may be accompanied by shoulder tendonitis and bursitis.

Who is likely to develop shoulder impingement syndrome?

This condition is commonly caused by overuse and can affect young people as well as older adults. Athletes who participate in sports that have repetitive overhead movements, such as swimmers, pitchers and tennis players, are susceptible to shoulder impingement. Also, adults who perform repetitive movements, such as lifting or overhead activities like weightlifting, painting, wallpaper hanging or construction work, can develop the problem.

What are the symptoms of shoulder impingement syndrome?

Usually, the symptoms associated with shoulder impingement syndrome begin mildly and increase over time. In its early stages, the achy pain goes away soon after or within a day after the activity is finished. However, as the syndrome progresses, the condition becomes chronic and any type of overhead activity, including something as simple as reaching up into a kitchen cabinet, can cause pain.

Shoulder impingement syndrome symptoms may include:

  • Pain and discomfort in the shoulder that is present both at rest and with activity, particularly when performing movements that require the arms to move above shoulder level. Often the pain is sudden with lifting and reaching movements, and sometimes the pain radiates from the front of the shoulder to the side of the arm.
  • Mild to moderate weakness, especially worse with overhead activity.
  • Local swelling and tenderness in the front of the shoulder.
  • Mild popping or crackling sensations in the shoulder.
  • Possible numbness or tingling in the hands.
  • Trouble finding a comfortable position for sleep.

How is shoulder impingement syndrome treated?

Non-surgical treatment
The initial and preferred treatment for shoulder impingement syndrome is non-surgical alternatives. They might include:

  • Rest and avoidance of overhead and repetitive activities.
  • Oral anti-inflammatory medications.
  • Cold therapy.
  • Ultrasound therapy to stimulate the tissues and improve blood flow.
  • Physical therapy, including stretching and strengthening exercises.
  • Steroid/cortisone injection.

Surgical treatment
If, after several weeks to several months, the non-surgical treatment options don’t help, an orthopaedic surgeon may recommend surgery. The goal of surgery for this syndrome is to remove the impingement and create more space for the rotator cuff. This allows the ball on the end of the upper arm bone to move freely so the arm can be lifted without pain. This form of surgery is called subacromial decompression or anterior acromioplasty.

Depending upon the surgeon’s preference and the injury, the surgery may take one of two forms: open or arthroscopic.

  • Open surgical repair requires a small incision in the front of the shoulder. In most cases, the front edge of the acromion is removed along with some of the bursal tissue to create space.
  • Arthroscopic repair makes use of a fiberoptic scope connected to a video camera and small, specialized instruments. The scope and instruments are inserted into small puncture-type incisions rather than through a larger, open incision. The surgeon then removes bone and soft tissue.

The arm may be immobilized after surgery for the initial healing process. Soon after, a physical rehabilitation program will be used to regain range of motion and strength in the shoulder and arm. It may take several months to rehabilitate the shoulder and have pain subside.