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Shoulder Impingement

Shoulder Impingement

Shoulder impingement occurs when pressure is placed on the rotator cuff from part of the shoulder blade when the arm is lifted. The tendons of the rotator cuff become compressed between the shoulder blade and the humerus (upper arm bone), causing inflammation (leading to tendonitis or bursitis) that can lead to pain, stiffness, tenderness, limited mobility and even a torn rotator cuff.

What is Shoulder Impingement?

Shoulder impingement occurs when pressure is placed on the rotator cuff from part of the shoulder blade when the arm is lifted. The tendons of the rotator cuff become compressed between the shoulder blade and the humerus (upper arm bone), causing inflammation (leading to tendonitis or bursitis) that can lead to pain, stiffness, tenderness, limited mobility and even a torn rotator cuff. Shoulder impingement is the leading cause of shoulder pain.

What causes Shoulder Impingement?

Shoulder impingement is caused by a portion of the shoulder blade pressing on the rotator cuff when the arm is lifted. The rotator cuff is a set of tendons that connect four main muscles in the shoulder, allowing an individual to rotate and lift the shoulder. Compression is typically caused by either a bone spur that rubs or pinches the tendons or an inflammation of the bursa, the lubricating sac that surrounds the rotator cuff. Impingement of the rotator cuff is most likely to occur in individuals that spend a lot of time with their arms stretched overhead or that do repetitive heavy lifting, including athletes, such as swimmers and baseball players, as well as those in certain professions, such as construction or painting.

What are the symptoms of Shoulder Impingement?

Symptoms of shoulder impingement include pain, swelling, tenderness and possible decreased mobility or strength. Minor impingement of the rotator cuff may cause pain that radiates from the front of the shoulder to the side of the arm. The pain may be felt during activity, when reaching the arm overhead, when lifting the arm, or when lowering the arm from an elevated position. There may also be localized swelling and tenderness felt in the front of the shoulder. At the beginning stages, pain is relatively minor but begins to increase as the problem progresses. Moderate cases of shoulder impingement may result in decreased mobility or strength, and it may be hard to perform tasks that require the arm to reach behind the back. Pain may also be felt even at rest. When the impingement becomes severe, all movement of the arm may be painful or there may be a complete loss of mobility. The rotator cuff can become torn. A loss of mobility can then result in frozen shoulder if left untreated.

How is Shoulder Impingement diagnosed?

A medical professional will take a complete medical history and will perform a physical exam. Questions will be asked related to when the symptoms began, what activities caused the symptoms, what worsens or relieves symptoms, and the relative severity of symptoms. A physical exam will involve various movements of the arm and shoulder to test for flexibility, mobility, strength, tenderness and pain. X-rays or an MRI may be used to confirm or rule out impingement or other conditions that cause shoulder pain. An injection of a local anesthetic may be done into the bursa surrounding the rotator cuff (called an impingement test) and if pain subsides, a diagnosis of shoulder impingement can confidently be made.

When should I seek care for Shoulder Impingement?

If you experience shoulder pain, tenderness or stiffness that does not go away after a short period of rest, limitation of activities that exacerbate the pain, application of ice, and over the counter nonsteroidal anti-inflammatory medications, you should seek medical advice. If you lose strength or mobility in your shoulder, or pain is severe enough to limit mobility, you should seek immediate medical attention.

What will the treatment for Shoulder Impingement consist of?

Treatment for shoulder impingement will typically begin with a course of rest, ice, and a nonsteroidal anti-inflammatory medication, as well as limiting the activities that cause pain (such as activities that require the arm to be outstretched above the head). Injections of steroids and an anesthetic into the area of impingement may be helpful in relieving pain and inflammation and can result in a limited period of improvement, extended relief or even complete recovery. Physical therapy is also recommended and may need to be followed for weeks or months as gradual improvement is made. If treatment is unsuccessful or the impingement is severe, surgery may be required to remove the cause of the impingement. Following surgery, rehabilitation is required for a number of months in order to increase strength and improve range of motion.

Which muscle groups/joints are commonly affected by Shoulder Impingement?

Shoulder impingement results when a portion of the shoulder blade compresses the rotator cuff, located within the shoulder joint. Pain, stiffness and limited mobility may occur in the shoulder or arm.

What type of results should I expect from the treatment of Shoulder Impingement?

In some cases, minor shoulder impingement may clear up with a short course of rest and limited activity or injections of steroids combined with an anesthetic. Most patients that follow a structured physical therapy program or that elect to have surgery followed by months of rehabilitation will be successful in alleviating the pain, stiffness and limited motion that can be caused by moderate or severe shoulder impingement. This improvement is usually gradual and may take up to a year to be achieved. Some patients will still experience some pain and inflammation on occasion even following recovery.