What is Impingement Syndrome?
Impingement syndrome refers to a condition involving compression or pinching of tissues between two nearby structures in the body. This syndrome commonly occurs in the shoulder joint where tendons, bursae, and muscles pass through a narrow space beneath the acromion, the bony protrusion of the shoulder blade. Any activity that involves repeated overhead arm motions can potentially lead to impingement syndrome over time due to overuse and fatigue of the shoulder tissues.
Causes of Impingement Syndrome
There are several potential causes of impingement syndrome in the shoulder:
– Repetitive overhead activities: Jobs or sports that require lifting arms above shoulder level on a frequent basis are a major risk factor. Examples include painting, serving, swimming. tennis. etc.
– Poor posture: Slouching forward with rounded shoulders keeps the arms in an elevated position and narrows the subacromial space.
– Degenerative changes: Natural wear and tear can cause spurs or calcifications to form on the acromion over decades of use, further restricting space.
– Injury history: Prior shoulder dislocations, fractures or labral tears may alter shoulder mechanics in a way that predisposes to impingement.
– Bone shape abnormalities: Some people are born with congenital variations like a curved acromion that inherently crowds the shoulder joint space.
Common Symptoms
The hallmark symptoms of impingement syndrome include:
– Pain in the front or side of the shoulder that gets worse with overhead activity or lying on the affected side. Raising the arm may elicit sharp pain.
– Tenderness over the front of the shoulder and/or top of the arm.
– Grating, popping or grinding sensation in the shoulder joint.
– Reduced shoulder strength and range of motion, especially with external rotation and abduction.
– Swelling or stiffness around the shoulder.
– Difficulty sleeping on the involved side due to discomfort.
Diagnosis and Testing
Physicians can usually diagnose impingement syndrome based on a patient’s medical history and physical exam findings. Imaging tests like x-rays may be ordered to rule out other conditions and assess bone structure. MRI scans can better visualize soft tissues like tendons and cartilage. Diagnostic injections sometimes help pinpoint the source of pain. If conservative care fails, arthroscopy allows direct visualization of shoulder structures during surgery.
Non-Surgical Treatment Options
Mild to moderate impingement syndrome is often initially managed non-operatively:
– Activity modification: Reducing repetitive arm motions that exacerbate symptoms, especially overhead activities.
– Rest: Taking complete rest from painful activities in the initial phase of treatment.
– NSAIDs: Over-the-counter anti-inflammatory medications can help relieve pain and swelling.
– Corticosteroid injections: These target inflamed tissues deep in the shoulder joint.
– Physical therapy: Ultrasound, ice, stretching and strengthening exercises are prescribed to improve mobility and posture.
– Bracing/taping: External support stabilizes the shoulder joint and protects vulnerable tissues.
– Lifestyle changes: Proper ergonomics, posture correction, weight loss if overweight.
Surgical Intervention
If nonsurgical methods fail to effectively relieve pain and restore function over several months, arthroscopic surgery may be recommended. Common surgical procedures for impingement syndrome include:
– Subacromial decompression: Removal of bone spurs on the acromion to enlarge the tight space.
– Acromioplasty: Shaving down a prominent or hooked acromion to flatten the bone.
– Biceps tenodesis: Repairing or releasing the biceps tendon if a SLAP tear or dislocation is present.
– Labral reconstruction/repair: Fixing a torn or detached labrum.
– Rotator cuff repair: Reattachment of tendon tears if diagnosed.
Post-surgical physical therapy is pursued to maintain shoulder mobility and avoid re-injury upon returning to normal activities. With a successful procedure and rehabilitation, pain relief and functional improvement are expected outcomes.
Conclusion
In summary, impingement syndrome is a common cause of shoulder pain resulting from compression of soft tissues in the subacromial space. While lifestyle modification and nonsurgical care provide relief for many cases, refractory or advanced impingement may necessitate arthroscopic surgery to correct underlying mechanical factors and repair related damage. With appropriate treatment and rehabilitation, patients usually experience good long-term outcomes.
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1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile