Shoulder Impingement

Overview

A shoulder impingement is a condition in which the tendons of the rotator cuff and/or the bursa (a fluid-filled sac that provides cushioning and reduces friction) in the shoulder joint are compressed or pinched. This can cause pain and limited mobility in the shoulder. Impingement can be caused by a variety of factors, including overuse, poor posture, muscle imbalances, and bone spurs. It is a common problem, particularly among athletes who use their arms in overhead motions, such as baseball players, tennis players, and swimmers. Treatment may include rest, physical therapy, medication, and in some cases, surgery.

Types of Shoulder Impingement

Currently, there exist four main categories of shoulder impingement syndrome, which are Primary Impingement, Secondary Impingement, Subcoracoid Impingement/Stenosis, TUFF’s (Tensile Under-Surface Fiber Failure) Lesion, Internal (Glenoid) Impingement, and Posterior-Superior Glenoid Impingement (PSGI). For effective treatment, rehabilitation, and/or surgical intervention, it is crucial to accurately diagnose the specific type of impingement syndrome affecting the shoulder.

Symptoms of Shoulder Impingement

The symptoms of shoulder impingement can include:

Pain in the shoulder, which may be a dull ache or a sharp, stabbing pain.
Weakness or loss of strength in the affected shoulder.
Limited range of motion in the shoulder joint, especially when reaching overhead or behind the back.
Pain that worsens with overhead activities, such as throwing a ball, lifting weights, or reaching for objects on high shelves.
Pain that is worse at night, especially when lying on the affected side.
Swelling or tenderness in the front or side of the shoulder.
A clicking or popping sensation in the shoulder joint.
A feeling of instability or looseness in the shoulder joint.

It is important to note that not all individuals with shoulder impingement will experience all of these symptoms, and the severity of symptoms can vary depending on the cause and extent of the impingement.

Causes of Shoulder Impingement

Shoulder impingement can be caused by a combination of factors. Some of the common causes of shoulder impingement include:

Overuse or repetitive overhead activities, such as throwing a ball, swimming, painting, or lifting weights.
Poor posture, which can cause the shoulder blade to sit too close to the rotator cuff muscles and cause compression.
Muscle imbalances or weakness, such as a weak rotator cuff or tightness in the chest muscles.
Bone spurs or other abnormalities in the bones of the shoulder joint.
Shoulder instability or dislocation, which can cause the humerus (upper arm bone) to move abnormally and cause impingement.
Aging and degeneration of the rotator cuff tendons and joint structures.
Trauma or injury to the shoulder, such as a fall or impact.

Diagnostics of Shoulder Impingement

Shoulder impingement can be diagnosed through a physical examination, medical history review, and imaging tests. During the physical exam, the doctor may move the arm and shoulder in various directions to check for pain, weakness, and limited range of motion. The doctor may also ask about any past injuries or activities that may have contributed to the condition.

Imaging tests, such as X-rays, magnetic resonance imaging (MRI), and ultrasound, can help diagnose shoulder impingement by providing detailed images of the shoulder joint and surrounding structures. MRI and ultrasound are particularly useful in evaluating the soft tissues, such as the tendons and bursae, and can help identify the specific cause of impingement.

Complications of Shoulder Impingement

If left untreated, a shoulder impingement can lead to several complications, including:

Rotator cuff tears: Impingement can cause wear and tear on the rotator cuff tendons, which can eventually lead to a rotator cuff tear.
Frozen shoulder: Impingement can cause inflammation and pain, which can lead to a condition called frozen shoulder. This is a condition in which the shoulder joint becomes stiff and painful, making it difficult to move.
Bursitis: Impingement can also cause inflammation of the bursa, which is a small fluid-filled sac that provides cushioning and reduces friction in the shoulder joint. This can lead to a condition called bursitis, which causes pain, swelling, and stiffness in the shoulder.
Arthritis: If impingement is caused by arthritis, the constant rubbing and irritation can eventually lead to the development of arthritis in the shoulder joint. Arthritis can cause pain, stiffness, and limited mobility in the shoulder.

Treatment of Shoulder Impingement

The treatment for shoulder impingement depends on the severity of the condition and its underlying cause. Some common treatments include:

Rest and Activity Modification: Avoiding activities that worsen the symptoms and giving the shoulder time to rest can help reduce inflammation and promote healing.
Physical Therapy: Strengthening and stretching exercises can help improve shoulder mechanics, reduce inflammation, and relieve pain.
Medications: Over-the-counter pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) can help alleviate pain and swelling.
Steroid Injections: Corticosteroid injections can reduce inflammation and pain in the shoulder.
Surgery: If conservative treatments fail, surgery may be recommended. Surgical options can include subacromial decompression, acromioplasty, or rotator cuff repair.
Alternative Therapies: Some people find relief through alternative therapies such as acupuncture, massage therapy, or chiropractic care. However, the effectiveness of these therapies for shoulder impingement is not well-established and should be discussed with a healthcare provider.