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Impingement

Cause

Impingement occurs when there is excessive friction between tissues in a joint. In the shoulder, impingement often occurs when the rotator cuff rubs against the acromion. The rotator cuff is a group of tendon that sits between the humerus and acromion bones, and it is susceptible to be impinged if the space between tendon and bone decreases. 

 

Shoulder impingement is often a result of overuse. Using the shoulder a lot can cause the tendons of the rotator cuff to swell, decreasing the joint space, causing the cuff to rub against the acromion, leading to pain, irritation, and inflammation. Shoulder impingement can also be caused by bursitis (inflammation of the bursa). Bursa provides the lubrication for the cuff to slide freely during motion, so inflammation of this tissue can lead to issues.

Risk Factors

Risk factors for shoulder impingement include overhead athletes, certain occupations, age, previous injuries, and structural issues. Athletes in sports involving repetitive overhead motion like volleyball, swimming, tennis, and baseball, as well as occupations like construction, painting, and window washing may be at increased risk for this injury. Previous shoulder injuries, old age, and an abnormally shaped acromion also factor into impingement.

Symptoms

Symptoms of this injury include pain, weakness, and stiffness at the joint. This pain may be present during a variety of overhead activities, and may even ache at night. This injury can be diagnosed with a physical exam, X-Ray, and MRI.

Treatment

Impingement can firstly be treated with rest, ice, and generally avoiding motions that aggravate pain in the shoulder. Physical therapy can help improve strength and range of motion, while non steroidal anti inflammatory drugs like ibuprofen and aspirin can help relieve pain and reduce inflammation. If these methods are unsuccessful, steroid injection and surgery could help. 

 

There are a few methods of surgery for this issue. Surgeons may widen the subacromial space so the cuff no longer catches on bone, remove an inflamed part of the bursa, or perform an anterior acromioplasty, where part of the acromion is removed. Surgery can be performed arthroscopically or via open surgery.

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