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Impingment Syndrome

There can be many reasons you feel pain when lifting your arm. The most common cause of this pain is called Shoulder Impingement.Other names that are used to describe this condition include... Rotator cuff tendonitis.Bursitis.Supraspinatus tendonitis (one of the rotator cuff muscles).

What Is Impingement?

Impingement pain occurs because the rotator cuff tendon and bursa (see below) are compressed against bone (the acromion) as the arm is elevated. There is inflammation of the Rotator Cuff muscles and tendons and often the adjacent Bursa (which is a lubricating sac). As one lifts the arm, the Bursa and the Rotator Cuff rub on the overlying Acromion bone causing “impingement”.



The most common symptom is pain with movement, particularly elevation and rotation of the arm. It can also occur when loading the shoulder by lifting heavy objects. Patients often complain of loss of motion and power. In more severe cases people experience night pain which disturbs their sleep. The cause of night pain is unknown. The pain is often localised to the upper and outer area of the shoulder and upper arm and may extend (radiate) to the elbow.



Who Gets Impingement?

This condition can occur at any age. It is more common in people who use their arms above their head, particularly for repetitive tasks. It is also more common as you get older because the Rotator Cuff degenerates with age and is therefore more likely to become inflamed. The condition is also more common when the Acromion bone has a hook or spur (but up to 70% of people are born with a hooked Acromion and the majority of them do not have symptoms).
If the condition continues for weeks or months some people notice difficulty moving their shoulder. Occasionally it is very difficult to distinguish between a frozen shoulder and impingement, and early in the disease a frozen shouldercan look exactly like impingement These two conditions are very different and the correct diagnosis must be made because impingement is treated with physiotherapy while a frozen shoulder is not. Shoulder Impingement requires prompt and accurate diagnosis and treatment. If this occurs, it is more likely to have a full and uncomplicated recovery.

Investigations

An x-ray of the shoulder is usually performed. In more complicated cases other tests such as a MRI scans are required. This is especially true if one fails non operative treatment or if a complete Rotator Cuff tear needs to be excluded.

Treatment

Most cases of subacromial impingement will respond to conservative measures and only a small proportion of patients will come to surgery. The treatment options are:

  • Simple analgesia Subacromial impingement is often self limiting. Treatment with simple pain killers such as paracetamol or anti-inflammatories (e.g. ibuprofen) may well be sufficient.
  • Physiotherapy Physiotherapy designed to strengthen the rotator cuff muscles may be helpful.
  • Intrabursal steroid In cases that do not respond to the above measures an injection of steroid into the space around the shoulder (the subacromial bursa) may be considered. Steroids reduce inflammation and will prevent the repeated impingement on the supraspinatus tendon; by breaking this 'vicious circle' an injection will often result in a long term cure. Injections have a reputation for being painful; whilst patients may experience increased discomfort for 48 hours following injection, this is rarely severe.
  • Subacromial decompression When all conservative treatment options have failed surgery may be considered. This is an operation to increase the space between the humerus and the acromium. It may be done through a short incision at the front of the shoulder, but more frequently done by arthroscopic ('keyhole') surgery. Please read the section of Subacromal Decompression.

Remember

  • This condition is completely curable with non operative treatment.
  • Physiotherapy is very important.
  • Avoid overhead activity and heavy work until symptoms settle.
  • Rarely is surgery necessary.