Shoulder Impingement Syndrome

 

Shoulder impingement syndrome occurs when the tendons in the shoulder are irritated, inflamed or degenerated. This occurs from repetitive overhead motions or structural abnormalities in the shoulder, and it can be a painful condition in the shoulder.  Shoulder impingement syndrome is typically treated with activity modification, medication, and therapy. Surgical treatment may be used to relieve symptoms and restore function, when nonsurgical options don’t work.

Shoulder Anatomy

The shoulder is composed of three bones:

  • The humerus-upper arm bone
  • The clavicle-collarbone
  • The scapula-shoulder blade that moves on our back
  • An edge of the scapula-called the acromion, forms the top of the shoulder

There are a total of four joints in our shoulder complex. The humerus and the scapula form the main shoulder joint, the glenohumeral joint.

The glenohumeral joint is not a true ball-in-socket joint but is similar, in structure, to the hip. The top of the humerus is round, similar to a ball. It rotates in the shallow basin, referred to as the glenoid, on the scapula. A group of ligaments, called the joint capsule, are responsible for holding the ball of the humerus in position. Ligaments are strong tissues that provide stability.

These four muscles form a single cuff of tendon that connects to the head of the humerus bone. Why is this important? These muscles allow the arm to rotate, move upward to the front, back, and side.

How are you able to painlessly move your arm around in these motions? A fluid-filled sac, called the subacromial bursa. The subacromial bursa lubricates the rotator cuff tendons, and this allows us to perform smooth and painless motions. We use the rotator cuff muscles to perform overhead motions, in general, such as reaching for something higher up.

These motions, although they aren’t used frequently in everyday life, are used repeatedly during sports.

Impingement Syndrome Causes

Impingement syndrome usually occurs as a result of muscle imbalance around the shoulder. This places increased stress on the rotator cuff tendons.  Secondary impingement syndrome occurs because of the rubbing or pinching of the tendons and bursa that happens during repetitive overhead movements. Shoulder impingement syndrome happens when the space beneath the acromion is too small for the rotator cuff tendons.  The space may be too narrow because of a variety of instances, but the most common include structural abnormalities in the shoulder bones, bone spurs, or thickened tissues.

As the tendons and bursa rub together during movement, this causes friction, pain, and limited motion. Degenerated tendons can also become very painful. The tendons may develop tendonitis; the bursa may develop bursitis.  Both of which are painful conditions. If the inflammation continues, the rotator cuff tendons can tear or detach from the top of the humerus.

Impingement Syndrome Symptoms

Typically, shoulder impingement syndrome will cause a generalized aching pain in the shoulder and upper arm.  You may feel weakness and pain in the shoulder when you raise your arm for activities. Pain typically interferes with sleep and is more severe at night.

Impingement Syndrome Diagnosis

Your doctor should be able to diagnose shoulder impingement syndrome by reviewing your medical history and examining your shoulder. X-rays will normally be ordered to check for bone spurs or acromion abnormalities.  An MRI scan may be used for more detailed pictures of your shoulder, particularly the rotator cuff, the muscles and joint capsule.

Impingement Syndrome Treatment

Treatments for shoulder impingement syndrome are standard and include a rest from the irritating activity and ice packs or medication for pain and inflammation. Cortisone injections may be used.  Physical therapy will be used to regain motion and also to strengthen weakened muscles. This will help to eliminate or at least decrease the pain.

Impingement Syndrome Surgery

Surgery is only recommended when non-operative treatments have provided minimal or no improvement of your symptoms. However, surgery may be necessary to enlarge the space beneath the acromion. This allows the tendons to glide freely. Surgery may also be needed to trim the degenerated tendon, or remove bone spurs and the undersurface of the acromion, remove some of the bursa, and occasionally a small part of the clavicle. This surgery is typically performed arthroscopically.

During an open surgical repair, the surgeon makes a three or four inch incision over the shoulder in order to access the joint. Arthroscopic surgery is a less invasive surgical procedure, using an arthroscope and narrow surgical instruments that are inserted through the small incisions.

With arthroscopic technology, the surgeon will not need to open up your joint fully. The arthroscope can be used to remove bone spurs and excess bone and repair torn tissues.

Impingement Syndrome Surgery Recovery

The arthroscopic method of surgery usually leads to less pain in the early postoperative period.  It also has a reduced risk of infection, less blood loss, and less pain and stiffness. This is because only small incisions are used and less surrounding tissue is affected or exposed. The recovery process is obviously different for everyone, but it will typically it takes several months to recover from surgery with participation in rehabilitation therapy.

 

At SPORT, we will identify the source of your pain and then utilize state-of-the-art therapeutic techniques that focus on restoring your range of motion.

Depending on the specific condition and its severity, these treatment options may include physical therapy, over-the-counter anti-inflammatory medication, slings and supports, cortisone shots, or shoulder or elbow surgery.

If you have an acute or chronic shoulder or elbow injury that needs medical attention, call SPORT at (469) 200-28322 to arrange a consultation or you can request one online. Hurt today? We can arrange a same-day urgent care visit to ensure you get fast, effective relief.

Sports Physicians Orthopedics and Rehabilitation of Texas