What is Shoulder Impingement?
Shoulder impingement, sometimes called subacromial pain syndrome is a common cause of shoulder pain which occurs due to impingement of tendons or bursa in the shoulder, or from the bones of the shoulder. It is often referred to as ‘swimmer’s shoulder’ since it is very common in swimmers; however, it also affects athletes who repetitively use the shoulders, such as baseball and tennis players. It can also affect those who frequently perform heavy lifting overhead such as construction workers. Other risk factors can include bone and joint abnormalities.
The shoulder includes an area where soft tissues such as the ligaments, bursa, biceps tendon and rotator cuff are sandwiched between bones. This area, known as subacromial space is located above the shoulder’s ball and socket joint and below the acromion, the top of the shoulder. The subacromial space becomes smaller when the arm is raised, which results in painful pinching of the soft tissues when there is impingement in the shoulder.
Causes of Shoulder Impingement
Impingement is often caused through overuse of the shoulder. Repeated use can inflame the soft tissues, causing them to swell; this can lead them to ‘catch’ on the acromion. Injuries can also cause impingement, particularly torn labrum or rotator cuff tears. In some cases, shoulder impingement can actually cause these injuries. Another cause of impingement can be due to a narrow subacromial space. This can either be through inherited bone shape or arthritic changes to the bone.
Symptoms of Shoulder Impingement
The main symptom is sudden pain or a pinching sensation in the top of your shoulder when you elevate your arm overhead or backward. When you lift your arm, the space (bursa) between the rotator cuff and acromion narrows which increases pressure. Typical activities include reaching for something high, throwing a ball, reaching behind your back, or sleeping on your stomach with your arms out to the side or above your head. Other symptoms can include:
- Pain that goes from the front of your shoulder to the side of your arm
- Weakness in the shoulder or arm
- Pain that gets worse at night
- Minor but constant pain in your arm
Diagnosis of Shoulder Impingement
Your doctor will ask you some questions in order to gain an accurate description of your symptoms. This will include the nature, duration and location of the pain in your shoulder. If you have experienced any trauma in the shoulder region, however minor, it is worth mentioning this. You will then have a physical examination where your doctor will check your range of motion to look for any unusual movement, and look for symptoms such as tenderness or swelling.
If your doctor thinks you may have a more serious condition such as a rotator cuff injury or labrum tear, or cannot diagnose you, you will likely be referred for imaging tests. These usually consist of X-ray and MRI scans. An X-ray cannot show soft tissue, but it is used to identify bone spurs or other bone abnormalities that can cause shoulder impingement. An MRI scan can provide a more detailed view of the soft tissue around the shoulder, including inflammation and tearing of the rotator cuff and bursa. An MRI can sometimes be preceded by an Arthrogram which is another imaging procedure that involves injecting contrast dye into the joint to help tissue damage stand out.
Treatment of Shoulder Impingement
Most cases of impingement can be treated conservatively without the need for surgery. The aim of non-surgical treatment is to:
- Improve range of motion in the shoulder
- Reduce pain
- Restore joint function
- Reduce inflammation in the affected area
- Improve supporting muscle strength and posture to increase the shoulder’s subacromial space
Typical non-surgical treatment involves the use of oral anti-inflammatory medication such as ibuprofen. The recommended length of time for taking medication is 6 – 8 weeks as it often takes this long to fully resolve the problem. However, you should consult with your doctor if the medication you are taking causes any stomach irritation or bleeding.
Your doctor may also recommend a cortisone injection if your symptoms are not improving with oral anti-inflammatory medication. Cortisone is a potent anti-inflammatory drug which should only be used when necessary as it can result in weakening of the muscles and tendons if used repeatedly.
Rest is very important when treating shoulder impingement, so any strenuous exercise or movement that worsens the pain should be avoided. This can be difficult for sports people, but essential in order to gain a full recovery. It is not recommended that you use a sling when you have shoulder impingement as this can weaken and stiffen the shoulder.
Physical therapy is an effective treatment for shoulder impingement as gentle exercises will help to rebuild strength and range of motion. You will be referred to a physiotherapist if you doctor feels you will benefit from physical therapy. Sessions usually focus on the muscles in your arm, shoulder and chest which will help to improve the function of your rotator cuff. You are likely to be given some exercises that you can perform at home; it is important to do them as they can help speed up your recovery.
If non-surgical treatments do not respond, then you may need to consider surgery. This is usually carried out with minimally invasive arthroscopic (keyhole) surgery which involves the surgeon widening the space around your rotator cuff. This will allow it to move freely without rubbing or catching on your bone. The procedure is commonly known as subacromial decompression or acromioplasty.
Post-Operative Recovery
Following surgery, your arm will be placed in a sling for 1 – 2 week in order to immobilise the shoulder so it can begin to heal. You will be given a programme of physical therapy which will start with range of motion exercises, and gradually progress to stretching and strengthening.
Most people can return to normal activities around 2 – 4 months after surgery, although a full recovery can take up to a year, depending on the severity of the impingement, the type of surgery performed and the patient’s age.
Need Help?
If you are experiencing pain in your shoulder and you think it could be shoulder impingement, you can be seen by a Consultant Orthopaedic Shoulder Surgeon at One Ashford Hospital, usually within 48 hours. One Ashford Hospital is well placed to see patients with knee injuries from Ashford, Maidstone, Canterbury, Folkestone, Dover and all surrounding villages. To book an appointment, call the hospital direct on 01233 364 022 or email here.
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