Shoulder impingement is one of the most common causes of shoulder pain, and occurs when the acromion (outer end of the shoulder blade) and rotator cuff (tendons and muscles surrounding the shoulder joint) rub against each other as a result of increased pressure, which leads to irritation and inflammation in the bursa (jelly fluid between the joint bones).
Also known as swimmer’s shoulder or impingement syndrome, shoulder impingement can occur as a result of repetitive activity that strains the shoulder such as lifting heavy weights, tennis, swimming, and painting amongst other overhead activities and sports. This can lead to pain on the upper shoulder bone, as well as difficulty reaching behind the back and arm weakness.
Symptoms of Shoulder Impingement
Some of the common signs and symptoms of shoulder impingement include:
- Persistent pain while extending the arm backwards or overhead
- Inflammation of the bursa and rotator cuff
- Weakness of the arm and/or shoulder
- Stiffness of the shoulder
- Tenderness in the front part of the shoulder
- Tearing and wearing of the biceps muscles if not treated early
- Pain while sleeping on the affected side
Causes of Shoulder Impingement
The main cause of shoulder impingement is overuse or straining of the shoulder and arm through overhead and backward activities such as swimming, heavy weightlifting, softball, tennis, painting, baseball, construction or packing goods. These activities, when done for a long period of time can result in shoulder impingement.
The impingement syndrome can also be as a result of:
- Sore or irritated bursa
- Swollen or torn tendons
- Flat or bone spurs on the acromion
Diagnosis of Shoulder Impingement
During the diagnosis of a shoulder impingement, the orthopedic surgeon first checks the patient’s medical history, which is followed by a physical examination to know the causes of the shoulder impingement symptoms. Previous surgical procedures and the mobility of the arm are ALSO assessed, and to find out the presence of any other damage or arthritis, imaging tests such as MRI scan and x-ray will be carried out.
Treatment Options for Shoulder Impingement
Non-surgical Treatment of Shoulder Impingement
Medication: Specific anti-inflammatory drugs are recommended to aid in relieving the pain and recede the soreness. Injection therapy may are given when medication has not been effective.
Home remedies: An ice pack is recommended, which is effective in relieving soreness and pain. For this option, the patient is advised to place an icepack on the shoulder for approximately 15 minutes. Additionally, resting and avoiding activities that can strain the shoulder is highly recommended.
One should avoid using a sling if he/she has not undergone a surgical procedure as this can lead to stiffness and weakening of the shoulder.
Physical therapy: Physiotherapy is important in speeding up the healing process for shoulder impingement. This is done through mild exercising of the arm, shoulder and chest to help in regaining range of motion and strength. Some of the exercises include:
- Shoulder blade flexion where one stands with the arms and back straight and the palms facing forward. Stretch the chest outwards and the shoulders backwards and hold for 5-10 seconds. This motion is repeated a few times while holding the flex motion.
- Crossover arm stretch: This involves lifting the arm of the affected shoulder and pulling it with the other arm across the chest and holding for 5-10 seconds, then releasing.
- Doorway shoulder stretch: This exercise involves holding the doorway frame at shoulder height with the arm of the affected shoulder, turning the body slowly away from the arm and holding for 15-20 seconds.
Surgery for shoulder impingement is considered when conservative treatments are not effective. During the procedure, the tissues and bone spur are repaired through a procedure known as arthroscopic shoulder decompression surgery. An arthroscope and an instrument known as a shaver are inserted via small incisions, and part of the acromion is removed. This procedure helps in broadening the space between the rotator cuff and the acromion and therefore reducing friction. An arm sling is provided after the surgery but only for a short period in order to prevent stiffness.
Recovery After Shoulder Impingement Surgery
The arm sling provided after the surgical procedure is usually removed after 2-4 weeks whereby the patient can slowly resume his/her normal activities. The complete healing process takes an average of three to six months or even a year depending on the severity of the damage.
Our board-certified orthopedic surgeons at King’s have extensive knowledge of the full range of shoulder disorders and will help you find the ideal medical solution for your condition. You can get in touch by filling in the form below.
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