Impingement syndrome is a common shoulder condition that causes painful pinching in the front of the shoulder. It occurs when soft tissues like tendons in the shoulder get compressed or “pinched” as the arm is raised. This article will explain the causes, symptoms, diagnosis and treatment options for impingement syndrome.
What is Impingement Syndrome?
Impingement syndrome, also called subacromial impingement syndrome, occurs when the rotator cuff tendons and bursa located underneath the acromion process get squeezed or impinged as the arm is lifted. The rotator cuff is a group of tendons that connect muscles from the upper arm to the shoulder blade, allowing the shoulder to move freely. The bursa is a fluid-filled sac that cushions rubbing between bones and tendons.
When the space between the acromion and rotator cuff narrows due to injury or overuse, it leads to irritation and inflammation of the tendons. As the arm moves overhead, the inflamed tendons and bursa get compressed, causing a painful pinching sensation in the front of the shoulder. Over time, repeated impingement can damage the rotator cuff tendons.
Causes of Impingement Syndrome
Several factors can contribute to the development of impingement syndrome:
– Repetitive shoulder overhead activities: Jobs or sports that involve frequent overhead movements like swinging a tennis racquet or throwing a baseball put stress on the shoulder and increase risk.
– Postural issues: Having rounded shoulders from poor posture can angle the acromion downwards, squeezing the space needed for tendon clearance.
– Injury or trauma: A fall on an outstretched arm or sudden injury to the shoulder is a common cause of impingement.
– Bone spurs: Calcium deposits that form on the acromion due to aging or previous shoulder damage further reduce space and increase rubbing of tissues.
– Weak muscles: Shoulder muscles that provide dynamic stability like the rotator cuff play a role. Weakness leads to faulty mechanics and more impingement during arm motions.
Symptoms of Impingement Syndrome
The hallmark symptom of impingement syndrome is shoulder pain that gets progressively worse when the arms are elevated, such as when reaching or lifting overhead. Other common signs and symptoms include:
– Aching or sharp pain at the front or side of the shoulder
– Night pain that disturbs sleep
– Pain extending to the side of the neck, upper arm or forearm
– Decreased range of motion, particularly overhead
– Strength weakness
– Tenderness to touch over the front of shoulder
– Pain that worsens with repetitive overhead activities
The pain often starts gradually and increases in severity over time if left untreated. Some people notice crepitus, or crackling, sounds coming from the shoulder with certain motions.
Diagnosing Impingement Syndrome
A physical therapist or doctor will examine the shoulder through active and passive range of motion testing to reproduce symptoms. Special tests isolate impingement like the Neer impingement test and empty can test. Imaging studies are usually not required initially but may be ordered to rule out other issues if symptoms persist.
X-rays can detect bone spurs or arthritis changes that compress the space. Ultrasound or MRI provides the best pictures of soft tissues like tendons. They allow assessment of tendon damage, tearing or fluid collections in the bursa. Together, physical examination findings and imaging studies help confirm impingement syndrome as the source of shoulder pain.
Treatment Options for Impingement Syndrome
The goal of treatment is to reduce pain and inflammation, restore shoulder range and strength, and prevent further damage. Conservative options are tried first before considering surgery:
– Rest and activity modifications: Avoiding aggravating motions like overhead activities helps decrease inflammation.
– Icing: Applying ice packs for 15-20 minutes several times a day reduces pain and swelling.
– NSAIDs: Over-the-counter anti-inflammatory medication provides pain relief.
– Corticosteroid injections: An injected corticosteroid aims to reduce inflammation.
– Physical therapy: Strengthening and stretching exercises are essential. A therapist can perform soft tissue mobilization and manipulation.
– Modified duties or assistive devices: Using an arm sling or cane may allow better rest when needed.
– Lifestyle changes: Proper work setup, posture corrections, and weight management aid recovery.
For persisting or advanced impingement despite conservative care, arthroscopic shoulder surgery may be recommended to address problematic bone spurs or repair a torn rotator cuff. In severe cases, acromioplasty to shave and smooth the acromion may provide lasting relief.
Prevention of Impingement Syndrome
The best defense is a good offense when it comes to future shoulder issues. Maintaining proper posture, performing regular stretching and strengthening for the rotator cuff can help offset impingement syndrome risk, especially for those with repetitive overhead activities as part of their jobs or sports. Seeking early care once symptoms emerge also prevents progressive damage. With self-care and treatment, people affected by impingement syndrome regain full function and pain-free mobility of the shoulder.
1. Source: Coherent Market Insights, Public sources, Desk research
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