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Narrowing of the subacromial space

Overhead work

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Physical exam

Shoulder Treatment

Physical Therapy

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Impingement

What is it? And why does it happen?

Impingement occurs when there is excessive friction between tissues. In the shoulder, it often happens when the space between the acromion (shoulder blade) and a group of tendons called the rotator cuff increases, leading to excessive rubbing.

 

Shoulder impingement is often a result of overuse. Frequently using the shoulder can cause the tendons of the rotator cuff to swell, decreasing the joint space. This makes the cuff 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 leads to issues.

Risk factors for shoulder impingement
  • Overhead athletes

  • Jobs with overhead lifting

  • Age related (Increasingly common after age 50)

  • Previous injuries or structural issues of the shoulder 

 

Sports like volleyball, swimming, tennis, and baseball, as well as occupations like construction, painting, and window washing may increase the risk of this injury. Structural issues like an abnormally shaped acromion can also contribute to impingement.

What are the symptoms of impingement? And how can my doctor tell if I have this condition?

If you have pain, weakness, and stiffness at the shoulder joint, you may be experiencing impingement. This pain may be present during a variety of overhead activities, and may even ache at night. Impingement is related to a variety of conditions of the shoulder including bursitis and rotator cuff tendonitis. Dr. Urband will consider these other conditions in the diagnosis of your pain.

 

Your provider will take your medical history and provide a physical exam including assessing your range of motion. X-Rays can help to rule out diagnosis like arthritis while MRIs and ultrasounds can reveal rotator cuff injuries or bursitis.

How is impingement treated?

Impingement can firstly be treated with rest, ice, and generally avoiding motions that aggravate pain in the shoulder. Physical therapy can help improve strength, range of motion, and position of the scapula, while non steroidal anti inflammatory drugs like ibuprofen and diclofenac gel can help relieve pain and reduce inflammation. If your symptoms do not improve with these treatments, your doctor may recommend steroid injection or surgery. 

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How can I prevent this injury?

To prevent this injury, avoid overhead lifting and perform exercises that strengthen the rotator cuff. Stretching can decrease the pinching of tissues in the shoulder, while good posture or sleeping with a taller pillow can also help.

Surgical Treatment

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

References​

  1. https://my.clevelandclinic.org/health/diseases/7079-shoulder-impingement-syndrome

  2. https://shoulderelbow.org/2017/07/19/terrible-triad-elbow-fracture-dislocation/

  3. https://orthoinfo.aaos.org/en/diseases--conditions/shoulder-impingementrotator-cuff-tendinitis

  4. https://www.hss.edu/condition-list_shoulder-impingement.asp

  5. https://health.clevelandclinic.org/the-best-way-to-find-relief-from-the-pain-of-shoulder-impingement/

  6. https://www.healthline.com/health/shoulder-impingement

 Attribution for Images

1. Freygant M, Dziurzy  ńska-Białek E, Guz W, Samojedny A, Gołofit A, Kostkiewicz A, Terpin K - Polish journal of radiology. Polish Medical Society of Radiology (2014). f1-poljradiol-79-391.

 

 

 

OpenStax College. “Shoulder Joint”. Wikimedia Commons, 19 May 2013, https://commons.wikimedia.org/wiki/File:914_Shoulder_Joint.jpg.

2. RSatUSZ. “Subacromial Impingement with Supraspinatus Rupture”. Wikimedia Commons, 1 February 2017, https://commons.wikimedia.org/wiki/File:Subacromial_Impingement_with_Supraspinatus_Rupture.jpg.

3. Nasch92. “Neer Test”.  Wikimedia Commons, 10 August 2018, https://commons.wikimedia.org/w/index.php?search=neer+test&title=Special:MediaSearch&go=Go&type=image.
 

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Stretching

Operation Theater

Surgery