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Shoulder Impingement refers to a painful condition that occurs when soft tissues like tendons get compressed or “pinched” within the shoulder joint. The rotator cuff tendons, which connect the muscles that move the shoulder joint to the shoulder blade, get squeezed between the head of the upper arm bone (humerus) and the rim of the shoulder blade (acromion). This compression of the tendons causes irritation and inflammation resulting in shoulder pain.
Causes of Impingement Syndrome
There are a few key factors that can contribute to the development of shoulder impingement:
– Repetitive overhead arm motions: Repeatedly lifting the arms above head level to perform activities like throwing a ball, swimming, or working overhead puts extra strain on the rotator cuff tendons and increases the risk of impingement. Occupations like construction work that require frequent use of power tools above shoulder height are also linked to impingement.
– Poor posture: Having rounded shoulders that slump forward causes the acromion to tilt downwards resulting in a narrowing of the space for the rotator cuff tendons to pass through. This poor posture compresses the tendons more easily.
– Pre-existing shoulder issues: Conditions like arthritis in the acromioclavicular (AC) joint, tears in the rotator cuff tendons, and bone spurs in the shoulder joint can further reduce space for the tendons leading to impingement.
– Injury or overuse: A traumatic injury to the shoulder like a fall on an outstretched arm or overuse from repetitive sports/activities without sufficient rest can damage the tendons and make them more susceptible to impingement.
Symptoms of Impingement Syndrome
The classic symptoms of shoulder impingement include:
– Sharp or burning pain in the front, side or back of the shoulder that gets worse with overhead activities or sleeping on the affected side
– Pain and stiffness when lifting the arm, especially when lifting above head height
– Tenderness if pressure is applied over the front or top of the shoulder near the acromion
– Loss of normal shoulder movement and range of motion
– Pain that radiates down the arm occasionally
– Crepitus or crackling sound from the shoulder joint
– Weakness in lifting or rotating the arm
In severe longstanding cases, symptoms like numbness, tingling or swelling may appear due to pressure on local nerves from impingement. The dominant arm is usually affected more commonly.
Diagnosis of Impingement Syndrome
Doctors can diagnose shoulder impingement based on a thorough physical examination of the shoulder joint along with the patient’s medical history and symptoms. During examination, certain routine tests like the Neer impingement test and Hawkins-Kennedy impingement test may be performed to check shoulder movements that provoke pain.
X-rays and other medical imaging tests are also used to rule out other shoulder issues and detect underlying causes like bone spurs. An ultrasound, MRI or arthrogram can clearly show soft tissue injuries in the rotator cuff tendons and surrounding structures. MRIs are especially useful for detecting subtle tears in tendons.
Treatment for Impingement Syndrome
Conservative nonsurgical treatments are usually the first approach tried for shoulder impingement:
– Resting the shoulder and avoiding activities that worsen pain
– Applying ice packs to reduce inflammation
– Taking over-the-counter anti-inflammatory medications
– Physiotherapy involving strengthening and stretching exercises under supervision
– Cortisone injections into the shoulder joint in select cases
– Braces or strap to support the shoulder
If these conservative options fail to provide pain relief within 4-6 weeks, other procedures may be considered:
– Orthopedic surgery to shave/trim the bone spur or decompress the area
– Arthroscopic surgery to repair medium to large size rotator cuff tears
– Acromioplasty to surgicallyreshape the bone and increase tendon space
With appropriate treatment and rehabilitation, most patients notice significant improvement within 3 months. In long-standing chronic cases, complete resolution of symptoms may take longer. Recurrence is possible if risk factors are not addressed.
Alternative and Complementary Treatments
Along with conventional physiotherapy exercises, some complementary treatments may aid recovery from impingement syndrome:
– Chiropractic massage therapy to relieve muscle tension and improve blood circulation.
– Acupuncture for its anti-inflammatory and pain relieving properties.
– Yoga stretches like downward dog and child’s pose help increase shoulder flexibility gradually.
– Ice or heat therapy for 15-20 minutes a few times daily depending on pain level and swelling.
– Dietary and herbal supplements containing nutrients like garlic, omega-3 fatty acids, turmeric, and ginger may reduce inflammation.
– Mind and body practices like meditation helps relax muscles and manage pain.
While not a cure, these adjunct therapies can be safely added after consulting a doctor or physiotherapist. Proper form and limits are important to avoid aggravating the injury during recovery.
Long-Term Management
Once initial symptoms improve with treatment, the following measures help prevent recurrence of impingement syndrome:
– Maintaining an erect posture especially while working on a computer or using phones.
– Stretching and strength exercises targeting the rotator cuff muscles 2-3 times a week.
– Modifying activities to avoid repetitive overhead motions where possible.
– Losing weight if overweight since excess pounds put strain on shoulders.
– Proper warm up and cool down before and after exercise or sports.
– Addressing any underlying issues like poor posture or mobility impairments.
– Consulting a doctor before resuming high impact activities after recovery.
With self-care and lifestyle management along with medical guidance as needed, most people can effectively control impingement syndrome over the long-term. However, being active within limitations and consulting professionals for guidance is important.
