Shoulder Impingement occurs when there is compression or “pinching” of tissues (such as tendons) between two bones. This commonly occurs in the shoulder joint where the rotator cuff tendons travel under the acromion, which is the bony outgrowth of the shoulder blade. Constant pinching and inflammation in this space causes shoulder shoulder impingement.
Causes of Impingement Syndrome
There are a few key factors that can lead to shoulder impingement:
– Repetitive overhead motions: Continuous lifting of objects above shoulder height, such as in sports like tennis or swimming, puts strain on the rotator cuff tendons and increases risk of impingement. Occupations like painting or construction work are also risk factors.
– Postural issues: Poor posture that rounds the shoulders forward can decrease the space for the rotator cuff, leading to more frequent impingement syndrome. This is commonly seen in desk jobs that require hunching over a keyboard.
– Injury or trauma: A sudden forceful injury to the shoulder, such as a fall on an outstretched arm, can cause microtears in tendons and lead to impingement over time if not properly treated.
– Degeneration: The natural aging process and regular wear and tear cause the acromion to develop spurs that grow into the space meant for tendons, increasing chances of impingement. This is more common in older individuals.
– Poor muscle balance: Weakness in the rotator cuff muscles makes the tendons more susceptible to damage from overhead activities. Poor scapular stabilization muscles also reduce dynamic protection of the shoulder joint.
Common Symptoms
The main symptoms of impingement syndrome are:
– Pain in the front or side of the shoulder that is often worse at night
– Pain that increases with overhead shoulder motions like combing hair or reaching for something on a high shelf
– Sleep disturbance due to shoulder discomfort
– Catching, clicking or grinding sensation in the shoulder
– Tenderness when pressure is applied directly over the affected tendons
– Weakness and reduced range of motion on internal and external shoulder rotation
– Referral of pain down the arm is possible in more severe cases
Diagnosis and Treatment
Doctors will typically do a physical exam to check for trigger points of tenderness and weakness. Imaging tests like x-rays or MRI may be done to rule out other injuries or assess the severity of impingement syndrome.
Conservative treatment options include:
– Resting the painful shoulder and limiting aggravating activities
– Applying ice regularly to reduce inflammation
– Taking over-the-counter anti-inflammatory medications
– Doing gentle stretching and range of motion exercises daily
– Strengthening exercises for the rotator cuff and scapular muscles
– Getting cortisone injections or platelet-rich plasma (PRP) injections in severe cases
– Physiotherapy involving ultrasound, massage, postural correction advice
If symptoms persist after 3-6 months of conservative care, surgical options may include arthroscopic decompression to remove bone spurs or repair torn tendons. Complete recovery typically takes 4-6 months after surgery.
Making Lifestyle Changes
Some important lifestyle modifications can help prevent recurrence of impingement syndrome:
– Maintaining good posture and being mindful of shoulder positioning
– Varying activities to limit repetitive overhead movements
– Doing regular strength exercises to support the shoulder joint
– Proper warm-ups, cool-downs and stretching before and after activity
– Using ergonomic equipment at work or limiting overhead work wherever possible
– Trying alternate hobbies or sports that are less stressful on shoulders
– Seeking physio or massage therapy on a monthly basis for maintenance
The take-home is that impingement syndrome is a common overuse injury that needs a multifaceted treatment approach of rest, anti-inflammatories, exercises and lifestyle changes. With proper care, full recovery is very much possible.