Submitted by Terrence Delaney, M.D.
Shoulder impingement, or impingement syndrome, is perhaps the most common shoulder condition treated by the orthopaedic surgeon. The condition is caused when there is excessive pressure or wear on the rotator cuff muscles as they pass between the top of the humerus (arm bone) and the overlying acromion, or shoulder blade. There is often pain when the arm is lifted from the side, although pain may be produced with any combination of shoulder motions performed in daily living such as dressing, driving and grooming.
The rotator cuff itself is actually the combination of four relatively small muscles which cover the ‘ball’ of the shoulder joint and serve to stabilize the joint when it is used in day to day activities. Without a properly functioning rotator cuff the shoulder is prone to instability and poor function. The space occupied by the rotator cuff in usually less than ten millimeters or so, an anatomical fact that makes the tendon of the rotator cuff especially prone to wear and tear. The pain may be due to inflammation of the bursa, a fluid filled structure that lies between the cuff and overlying bony structures, or due to wear and even small tears in the cuff itself. This will often lead to inflammation in the surrounding structures around the joint which may lead to loss of motion, a condition referred to as ‘frozen shoulder’.
Impingement syndrome is often associated with overuse in young athletes as well as older ‘weekend warriors’. It is especially common in athletes who engage in sports which involve overhead activities such as tennis, swimming and baseball. In addition those whose who do repetitive lifting such as contractors, painters and machinists are also especially susceptible. Pain in the shoulder may also occur with minor trauma, or may occur gradually as part of the normal aging process.
Symptoms often arise gradually, with pain at extremes of motion or at rest. Often the individual will experience pain referred to the outer aspect of the shoulder or into the elbow. As the condition progresses there is often pain at night or to lie on the side, pain with overhead motion and difficulty performing daily activities.
The diagnosis is made by a combination of careful examination of the shoulder by an orthopaedist as well as a thorough history. X rays of the shoulder often show bone spurs in the shoulder which may decrease the already small space available for the rotator cuff to travel. MRI studies often show an increase of inflammatory tissues as well as possible tearing of the rotator cuff. Often an injection of local anesthetic will decrease the pain dramatically, a diagnostic test commonly known as the ‘impingement sign’.
Initial treatment consists of avoidance of activities which cause pain, application if ice and anti inflammatory medications. Further treatment often consists of local steroid injections as well as physical therapy to balance and strengthen the shoulder area. Relief of symptoms may take months.
If the patient does not respond to a well directed course of conservative care surgical treatment is an option. The goal of surgery is to relieve the source of impingement, removing any bone spurs and increase the space available for the rotator cuff to travel. This is usually done using arthroscopic surgical techniques as an outpatient procedure. At the time of surgery the entire shoulder is examined and any other areas of pathology are addressed and treated such as tears in the rotator cuff or biceps tendon. Post operative care depends on surgical findings and involves early range of motion and gradual strengthening as the rotator cuff repairs itself. Healing and return to activities may take up to a year.
Full return to activity can be expected in individuals who are treated before full tears of the rotator cuff develop and follow rehabilitation protocols as well as a consistent course of post surgical strengthening exercises.
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Written by Terrence Delaney, M.D.
Dr. Delaney is a specialist in orthopedic surgery, sports medicine and joint replacement surgery. He received his M.D. from New York Medical College in 1986 and went on to do a surgical internship at St.Luke’s Hospital/Columbia University in New York. He completed a four year Orthopaedic residency at Catholic Medical Center/Cornell University, in 1992. During this time he trained in spinal reconstruction and pediatric orthopaedics at NYU/Hospital for Joint Diseases as well as an advanced AO fracture and trauma course. He then completed a one year Joint Replacement Fellowship at Stanford University in Palo Alto . He has been in private practice in Los Gatos, California since 1993.
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After reading this article I have it to be very informative.It answered any questions that one might have on possible impingement on themselves.
I would defintely reccomend it to anyone with signs or symptoms,
Great Job!!
Great post – very informative. The preferred treatment for a Shoulder Impingement is a combination of anti-inflammatory medication and physiotherapy. Physiotherapy works to relieve your pain and to maintain or recover normal mobility of the shoulder joint. The physiotherapy consists of a number of sessions which includes mobility exercises to prevent or combat stiffness.
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