About Shoulder Impingement

Overview

Shoulder impingement is a painful condition that occurs when the tendons and soft tissues around the shoulder joint become trapped between the upper arm bone (humerus) and the acromion, a bony part of the shoulder blade. This compression can irritate or tear the soft tissues, leading to pain and limited range of motion in the arm. It often results from repetitive overhead activities, poor posture, or bone spurs. Symptoms include pain when lifting the arm or reaching overhead, and stiffness. Diagnosis typically involves a physical exam and imaging tests like X-rays or magnetic resonance imaging (MRI). Treatment usually includes rest, ice, physical therapy, pain relievers, and sometimes corticosteroid injections. In severe cases, surgery might be needed to address bone spurs or repair damaged tissues. Most people experience significant relief and improved function with proper treatment.

Causes and Risk Factors

Shoulder impingement can be caused by several factors. Overuse is the leading cause of shoulder impingement. This means that doing activities that require repeatedly moving the arm above the shoulder and toward the back can put a person at risk. Some examples of these activities include swimming, tennis, softball, baseball, painting, packing, lifting, and construction.

Some non-modifiable risk factors for shoulder impingement, which are factors that cannot be controlled to reduce the risk of developing the condition, include:

• Age: People who are 50 years old or older are more likely to develop impingement due to wear of tear of the shoulder joint
• Previous injuries, such as a dislocated shoulder and rotator cuff tears, can increase the risk of getting shoulder impingement
• Shoulder anatomy: Some people may have problems with the position or movement of their shoulder joint. This can reduce space within the joint and increase the risk of symptoms after even some light swelling of the tendons
• Bone spurs: Bone spurs are protruding bone that grow off an existing bone. These spurs may irritate the surrounding tissue, leading to swelling and impingement.

Some modifiable risk factors for shoulder impingement, which are factors that can be controlled to reduce the risk of developing the condition, include:

• Overuse stress: Participating in sports or occupations that involve repetitive movements of the arm and shoulder, such as hairdressing, tennis, swimming, and baseball.
• Shoulder rotational strength: Strengthening the muscles that rotate and stabilize the shoulder joint can help reduce the risk of impingement.
• Scapular dyskinesia: This refers to abnormal movement patterns of the scapula (shoulder blade). Addressing scapular dyskinesia through exercises and proper movement mechanics can help prevent impingement.

Symptoms

The most common early symptoms of shoulder impingement include:

• Intense pain, weakness, and reduced movement in the affected shoulder.
• Sudden pain in the shoulder when lifting the arm overhead or backward
• Minor but constant pain in the arm
• Pain that goes from the front of the shoulder to the side of the arm
• Pain that gets worse at night
• Shoulder or arm weakness

As shoulder impingement progresses or reaches a higher severity, additional symptoms may occur. These symptoms can include:

• Pain occurring with both activity and rest
• General stiffness and throbbing in the shoulder
• Swelling in the shoulder
• Increased difficulty sleeping on the affected side of the body

It's important to recognize these symptoms so that early intervention can be sought to reduce the risk of longer-term injury.

Diagnosis

To diagnose shoulder impingement, healthcare professionals use a combination of examinations, tests, and procedures. Here are the commonly performed ones:

• Physical examination: A doctor will ask you questions about your pain, any prior injuries, and steps taken to address the pain. They will also examine your shoulder for signs of injury, bruising, or swelling.
• Motion and strength tests: During a physical examination, a doctor may request that you perform certain motion and strength tests. These assessments involve moving your arms in different directions to check for pain and mobility problems. Some common shoulder impingement tests include the Neer test, Hawkins-Kennedy test, coracoid impingement test, cross-arm impingement test, and others.
• Imaging tests: In some cases, imaging tests may be necessary to visualize the internal structures of your shoulder. Common imaging tests include X-ray or magnetic resonance imaging (MRI). These tests help confirm the diagnosis, assess the extent of the damage, and rule out other potential causes of shoulder pain.
• Musculoskeletal ultrasonography: This imaging technique shows detailed pictures of muscles and joints, looking for signs of inflammation, partial tears, damage, or fluid buildup in the shoulder joint and the rotator cuff.

It's important to note that these examinations, tests, and procedures are conducted by healthcare professionals who specialize in diagnosing and treating shoulder conditions. They will use their expertise to determine the most appropriate course of action based on your specific symptoms and medical history.

Treatment Options

The main goals of treatment for shoulder impingement are to reduce pain and improve shoulder function. There are various treatment options available to achieve these goals. Treatment options include:

• Medication:
• Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications help reduce inflammation and relieve pain. They can be taken orally or applied topically as a cream or gel.
• Therapies:
• Physical therapy: This involves gentle exercises and stretches that aim to strengthen the muscles in the shoulder and restore range of motion. Physical therapy can also help improve posture and correct any muscle imbalances that may contribute to shoulder impingement.
• Occupational therapy: Occupational therapists focus on improving daily activities and functional movements. They may provide specific exercises and techniques to promote healing and improve shoulder function.
• Therapeutic procedures:
• Cortisone injections: In some cases, doctors may recommend injecting cortisone, a powerful anti-inflammatory medication, directly into the affected area. This helps reduce pain and inflammation.
• Surgical intervention: If non-surgical treatments are not effective, surgery may be considered. The surgical procedure aims to create more space for the rotator cuff by removing inflamed tissues, such as the bursa or part of the acromion.
• Self-care and health behavior changes:
• Rest: Giving the shoulder proper rest is crucial for healing. Avoiding activities that worsen the symptoms can help prevent further irritation.
• Applying ice: Applying ice packs to the affected area can help reduce pain and inflammation.
• Heat therapy: Alternating between warm showers or using heating pads can help relax muscles and promote blood flow to the area.
• Posture correction: Maintaining good posture can alleviate stress on the shoulder joint and prevent impingement.

It's important to note that treatment plans should be individualized. Speak with a healthcare professional for medication dosing and additional side effect information.