What Is Impingement Syndrome?
Impingement syndrome may occur when the tendons or bursa in the shoulder get impinged, or "pinched," by the bony structures of the shoulder. This syndrome may coincide with rotator cuff tendonitis or shoulder bursitis. It most often affects older, active adults by causing pain during overhead motions.
What Are the Symptoms of Impingement Syndrome?
Impingement syndrome can cause symptoms such as:
- Shoulder pain when reaching overhead
- Shoulder weakness
- Difficulty reaching behind the back
The severity of symptoms may increase if the rotator cuff tears or there is a tear in the tendon of the bicep muscle.
What Causes Impingement Syndrome?
The shoulder joint is unlike most parts of the body when it comes to structure. Here, instead of the bones being surrounded by tendons and muscles, the opposite is seen. Bone can be felt directly under the skin in this part of the body, with muscles and tendons located beneath. Beneath the bone that houses a shoulder joint is a group of muscles and tendons referred to as the rotator cuff. The rotator cuff sits between the top of the shoulder and the top of the arm bone. It is this situation of softer tissues sandwiched between bones that create the opportunity for impingement.
Injury or degeneration that causes the rotator cuff to swell creates pressure that reduces blood flow through the small vessels in the shoulder. Restriction in circulation leads to fraying of the tendon tissue and worsening swelling. This can result in aching pain when the arm moves in certain ways (behind the back or overhead).
Who Is a Candidate for Developing Impingement Syndrome?
A natural anatomical structure may affect a person's risk for impingement syndrome. When there is less space within the joint due to anatomy, even slight swelling can trigger symptoms. Additionally, impingement syndrome may occur when a person:
- Has suffered a shoulder injury.
- Engages in activities, such as tennis or swimming, that involve repetitive movement of the shoulder and arm.
- Has developed bone spurs in the shoulder joint due to wear and tear.
Impingement syndrome is also more common in older individuals.
Diagnosing Impingement Syndrome
When a patient presents with symptoms of impingement syndrome, thorough consultation and medical history is first conducted. This is followed by a physical examination of the joint and x-rays or other imaging that provides a clear image of the joint structure. Images display the joint space and can also help the doctor observe a rotator cuff injury and bone spurs if they have developed. Impingement syndrome may be diagnosed If pain is stopped by an injection of local anesthetic into the area of discomfort.
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Treating Impingement Syndrome
Impingement syndrome can often be managed with conservative therapies such as ice and appropriate medications. Ice may be applied to the shoulder for periods of approximately 20 minutes. The cold reduces pain and can also decrease swelling. Over-the-counter medications also reduce inflammation. Finally, a doctor may prescribe an organized physical therapy program to build up strength and flexibility in the muscles and tendons that support the shoulder joint. In addition to recommended activities, patients with impingement syndrome are also encouraged to rest. Activities that worsen inflammation and pain, such as a sport, should be avoided until comfort improves.
The vast majority of people with impingement syndrome improve with the abovementioned protocols. If symptoms persist after these treatments have been completed, further diagnostic imaging may be recommended. An MRI can confirm or rule out a rotator cuff tear. If the rotator cuff has torn, surgical repair may be necessary.
Side Effects of Impingement Syndrome Treatment
Conservative treatments that involve medication of any kind, whether over-the-counter or prescription, may cause indigestion or upset stomach. These common side effects can usually be avoided by taking medication with a meal. Although not very common, it is possible that anti-inflammatory medication may cause constipation, vomiting, or a stomach ulcer.
An injectable medication, such as cortisone shots, may also cause side effects, but these usually depend on the frequency of treatment and dosage of the medication. In some patients, cortisone shots may raise blood sugar or cause weight gain. The risk of elevated blood pressure, cataracts, and osteoporosis may also increase. Again, this is dependent on the longevity and aggressiveness of treatment.