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Shoulder Impingement

Shoulder impingement occurs when the front of the shoulder blade rubs against the rotator cuff causing irritation and pain. The rotator cuff is a group of muscles and tendons that stabilizes the shoulder and permits lifting and rotating movements. If the rotator cuff weakens or is injured, the bone of the upper arm (humerus) can lift up, pinching the rotator cuff against the shoulder blade. The muscles can then swell further, creating a cycle of pain and weakness that worsens over time. Shoulder impingement is one of the most common causes of shoulder pain and occurs more frequently in athletes who lift their arms overhead, such as swimmers, baseball players and tennis players.

CAUSES OF SHOULDER IMPINGEMENT

Shoulder impingement is often caused by the weakening of, or injury to, the shoulder tendons which may be due to:

  • Aging
  • Rotator cuff injuries
  • Tendonitis
  • Bursitis

Shoulder impingement may also be caused by overuse of the rotator cuff, and may be more common in people who do repetitive lifting or activities that include frequent raising of the arm, such as construction workers, painters or athletes. In some cases, impingement may occur without a discernible cause.

SYMPTOMS OF SHOULDER IMPINGEMENT

The symptoms of shoulder impingement often worsen over time. Initial symptoms may include mild pain in the shoulder, and may progress to

  • Pain radiating from the front of the shoulder to the side of the arm
  • Sudden pain when lifting and reaching the arm
  • Swelling and tenderness in the shoulder
  • Loss of strength and motion

As impingement progresses, pain and stiffness may worsen until it becomes difficult to lift or lower the arm. Left untreated, shoulder impingement may severely limit arm motion to the point that the shoulder becomes "frozen."

DIAGNOSIS OF SHOULDER IMPINGEMENT

Shoulder impingement may be diagnosed after a review of symptoms and a physical examination of the shoulder. Additional tests may include X-rays or an MRI scan to rule out any other conditions that may be causing symptoms. A doctor may also test the individual's range of motion and arm strength by asking the patient to perform different actions with the arm and shoulder.

TREATMENT OF SHOULDER IMPINGEMENT

Treatment for shoulder impingement focuses on managing pain and restoring function of the shoulder. Initial treatment may include rest and modifying physical activities as well as:

  • Anti-inflammatory medication
  • Steroid injections
  • Physical therapy

Surgery is rarely recommended for shoulder impingement, however, in severe cases that do not respond to other treatment, arthroscopic surgery may be performed to remove the tissue that may be irritating the rotator cuff.

WHEN IS SURGERY NECESSARY TO FIX A SHOULDER IMPINGEMENT?

Surgery is a last resort for treating shoulder impingement syndrome and most often this condition is treated successfully with nonsurgical management. Before deciding that surgery is necessary, a doctor may recommend a variety of conservative treatments. Initially, a patient may apply ice or take anti-inflammatory medication to reduce the inflammation in the area of impingement. A doctor may also recommend a corticosteroid injection to relieve more severe symptoms. Physical therapy is sometimes prescribed to reduce pain and increase range of motion and strength.

Surgery may be necessary when conservative measures fail to alleviate the symptoms, or when there is also a torn rotator cuff. Our physicians are board-certified in orthopedic surgical procedures, including arthroscopic surgery. This technique is commonly chosen to repair varying degrees of rotator cuff damage. In the event of surgery, physical therapy will be needed afterwards to help restore range of motion and strength.

How long does an Arthroscopic surgery procedure take?

Arthroscopic shoulder surgery can take 30 – 90 minutes. However, patients should expect to be at the surgery center for approximately 4 to 5 hours for pre-operative evaluation and post-operative monitoring and care. Patients usually spend 1 to 2 hours in the recovery area while the anesthesia wears off. Most patients are comfortable enough after that amount of time to be discharged.

Can a shoulder impingement go away on its own?

Cases of spontaneous improvement have been noted. However, most people who develop a shoulder impingement can benefit from professional medical care. Your doctor will examine the shoulder and order x-rays or other imaging. In the case of suspected rotator cuff injury, more extensive imagine can rule out a more serious shoulder injury. Prompt care for symptoms of shoulder impingement can expedite the return of comfort and mobility.  If left untreated, this problem can persist chronically.

How long does a shoulder impingement take to heal?

If the rotator cuff is intact, shoulder impingement may heal in 3 to 6 months with ice, medication, rest, and physical therapy exercise. The timing is similar for patients who undergo arthroscopic surgery.

How can I prevent a shoulder impingement?

Shoulder impingement is an inflammatory condition that limits range of motion. Some ways to reduce the risk of this injury include:

  • Train smart. Doing too much too soon is a leading cause of shoulder impingement. If you are beginning a new sport or have played a sport for years, a proper warm-up is critical. You can also develop shoulder impingement by not increasing your workout routine at a reasonable pace. It is wise to introduce all new exercises gradually.
  • Balance muscle tone. It can be detrimental to focus on developing only the muscles at the front of the body. It isn’t uncommon for people to perform chest and arm exercises and neglect those in the back and around the shoulder blades. An imbalance between the muscles in the chest area and the upper back can predispose a person to inflammation.
  • Practice good posture. Slouching forward causes the shoulders to round, reinforcing poor shoulder movement. Good posture involves sitting with the shoulders back and the chest open. It can take concentration to build this habit, but it is necessary to avoid unnecessary strain on the upper body.
  • Manage minor inflammation. Some inflammation is unavoidable. If the shoulder feels sore after a tough workout or sport, apply ice for 20 minutes. Rest the shoulder if pain persists. Remember, doing too much too soon is a leading cause of shoulder impingement.  
  • Get the right technique for specific motions. If you are an athlete who moves your arm or arms overhead, you must develop sound mechanics to protect various joints. 

Can a shoulder impingement cause neck pain?

Yes. The most common symptoms of shoulder impingement stay local around the shoulder joint. Patients may have difficulty lifting the arms due to pain. Sometimes, pain can radiate from the shoulder to the neck or even to the arm.

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