Shoulder impingement syndrome is a condition where rotator cuff tendons of the shoulders are intermittently trapped and compressed during shoulder movements. Shoulder impingement syndrome, also called subacromial impingement, painful arc syndrome, supraspinatus syndrome, swimmer’s shoulder, and thrower’s shoulder. This causes injury to the shoulder tendons to become irritated and inflamed.
We commonly see impingement syndrome in active adults, especially as they get older. Shoulder impingement may cause shoulder bursitis and rotator cuff tendinitis. These conditions may occur alone or in combination. This commonly results in painful shoulder movements but can lead to significant functional weakness with a rotator cuff tear.
Shoulder Impingement Syndrome Symptoms
The shoulder impingement symptoms are different for each of the different causes. The most common symptoms of shoulder impingement symptoms are the pain, weakness and a loss of movement at the affected shoulder.
- Pain in the top and outer side of your shoulder. This pain has a very nagging character.
- Pain that’s worse when you lift your arm, especially when lifting your arm above 80 degrees sideways.
- Pain or aching at night, which can affect your sleep
- Weakness in your arm
Another give away sign of shoulder impingement is the pain in an arc from about 70 degrees to 130 degrees when lifting the arm out sideways and up above the shoulder.
Shoulder Impingement Syndrome Causes
Shoulder Impingement Syndrome is frequent in athletes who do their arms overhead for swimming, baseball, and tennis. Those who do repetitive overhead activities using the arm, such as paper hanging, construction, or painting are also susceptible.
Shoulder impingement Syndrome happens when the tendon rubs on the bone at the top of this space, called the acromion.
This can be caused by bony structures such as subacromial spurs, osteoarthritic spurs on the acromioclavicular joint. Calcification of the coracoacromial ligament can also cause Shoulder Impingement Syndrome. Due to injury or loss of strength of the rotator cuff muscles may cause the humerus to move superiorly, resulting in impingement. Inflammation and subsequent thickening of the subacromial bursa may also cause impingement.
Pain may also develop as the result of a minor injury. Sometimes, it occurs with no apparent cause.
Shoulder Impingement Syndrome Diagnosis
Shoulder Impingement syndrome can usually be diagnosed by history and physical exam. On physical exam, the physician may twist or elevate the patient’s arm to test for reproducible pain (Hawkins-Kennedy test, Neer test, & Drop arm test).
- Hawkin’s test
Patient position on standing or sitting upright position with arm fully adducted & forwardly flexed.The elbow is flexed.
The examiner will place one hand on the patient shoulder and apply internal rotation to the affected arm with the other hand.
Pain at the shoulder indicates subacromial impingement.
- Neer’s test
Patient position on standing or sitting upright position. The examiner will passively elevate the pronated arm of the patient above the level of the shoulder.
Pain in the anterolateral aspect of the shoulder indicates subacromial impingement.
- Drop arm test
Patient position on standing or sitting upright position. The patient is asked to hold the affected arm in abduction at the level of the shoulder then smoothly adduct the arm.
A patient suffering from rotator cuff tear will not be able to hold the arm in abduction and the arm will drop rapidly.
Plain x-rays of the shoulder used to detect some joint pathology and variations in the bones, including acromioclavicular arthritis, variations in the acromion and calcification. Nevertheless, x-rays do not allow visualization of soft tissue and thus hold a low diagnostic value. Ultrasonography, arthrography, and MRI can be done to disclose rotator cuff muscle pathology. MRI is a genuine imaging test prior to arthroscopic surgery.
Shoulder Impingement Treatments
Avoid things that make the pain worse–avoid activities that involve repeatedly lifting your arm above your head for a few days or weeks. Ask your physiotherapist when you can restart these activities.
Don’t stop moving the arm completely – try to carry on normal daily activities, so your shoulder doesn’t become weak or stiff. It’s best to avoid using a sling.
Keep an ice pack on your shoulder for throughout 20 minutes several times a day – wrap it in a towel first.
Anti-inflammatory painkillers or paracetamol may help. Your physicians can prescribe stronger painkillers if required. Drugs like ibuprofen and naproxen reduce pain and swelling.
Shoulder Impingement Exercises
Your physiotherapist will diagnose shoulder impingement syndrome and suggest Shoulder Impingement exercises to help improve shoulder posture and further strengthen your muscles to eliminate your pain and increase the range of movement.
If rest, medications, and physical therapy do not relieve your pain, Steroid injections into your shoulder can help relieve pain from Shoulder Impingement Syndrome. Steroid injections usually only have an effect for a few weeks and your pain may come back if you stop the exercises. A physical therapist will focus on restoring normal motion to your shoulder. Stretching exercises to improve range of motion is very helpful for Shoulder Impingement.
Shoulder Impingement Surgery
When nonsurgical treatment does not relieve pain, your doctor may recommend Shoulder Impingement surgery. An operation called a subacromial decompression may be an option. This involves widening the space around the rotator cuff tendon. These procedures can be performed using either an arthroscopic or open technique.
In arthroscopy, thin surgical instruments are inserted into two or three small puncture wounds around your shoulder. It’s usually done under general anaesthesia.
In open surgery, your surgeon will make a small incision in the front of your shoulder joint. This enables your surgeon to see the acromion and rotator cuff directly.
After surgery, your arm may be placed in a sling for a short period of time. This allows for early healing.
Your physiotherapist will provide a rehabilitation program based on your needs and the findings of Shoulder Impingement surgery. This will include exercises to regain range of motion of the shoulder and strength muscles of the arm. For shoulder surgery recovery time typically takes 2 to 4 months to achieve complete relief of pain, but it may take up to a year.