Shoulder Impingement, from an Orthopedic Surgeon’s Perspective

Shoulder Impingement, from an Orthopedic Surgeon’s Perspective

Shoulder impingement refers to a condition where the tendons of the rotator cuff muscles become irritated or compressed as they pass through a narrow space called the subacromial space. This space is located beneath the acromion, a bony projection on the scapula (shoulder blade). When this space becomes narrowed, the tendons can rub against the acromion, leading to inflammation, pain, and sometimes tears of the rotator cuff.

In simple terms, shoulder impingement occurs when there is a mechanical blockage or “pinching” of the tendons and bursa (a fluid-filled sac that cushions the tendons) in the shoulder. If left untreated, it can lead to more severe conditions like rotator cuff tears or shoulder instability.

Causes 

1. Repetitive Overhead Movements: Activities that involve repeated overhead motions, such as swimming, tennis, weightlifting, or painting, can gradually lead to the compression of the rotator cuff tendons.

    

2. Aging: As we age, the tendons in the shoulder can naturally degenerate, becoming less flexible and more prone to irritation. This is a major factor in the development of impingement in older adults.

    

3. Poor Posture: Slouching or having a forward-rolled shoulder posture can reduce the available space in the subacromial region, leading to impingement. Over time, this posture can contribute to tendon friction and inflammation.

    

4. Shoulder Injuries: Past shoulder injuries, such as fractures, dislocations, or sprains, can change the shape of the acromion or alter the normal mechanics of the shoulder joint, increasing the risk of impingement.

    

5. Structural Abnormalities: In some cases, individuals may have a naturally narrow subacromial space due to the shape of the acromion bone, which can predispose them to impingement.

    

6. Muscle Imbalances: Weakness or imbalance in the rotator cuff muscles or the muscles around the scapula can lead to altered mechanics, putting additional stress on the shoulder joint and contributing to impingement.

    

Symptoms 

• Pain in the Front or Outside of the Shoulder: This pain often worsens with overhead activities, such as reaching or lifting. In some cases, it can radiate down the arm.

   

• Difficulty Raising the Arm: Patients may experience limited range of motion, particularly when trying to lift the arm overhead or reach behind the back.

   

• Night Pain: Pain that worsens at night, especially when lying on the affected shoulder, is a hallmark symptom of shoulder impingement.

   

• Weakness: There may be noticeable weakness in the shoulder, particularly with lifting or carrying objects.

   

• Clicking or Popping Sensation: Some people report a clicking, popping, or catching sensation in the shoulder when moving the arm.

   

If you or someone you know is experiencing any of these symptoms, it’s important to consult with an orthopedic specialist for an accurate diagnosis and appropriate treatment.

Treatment for Shoulder Impingement: An Orthopedic Surgeon’s Approach

Treatment for shoulder impingement typically begins with conservative measures, but if these do not provide relief, more advanced interventions may be necessary. Our goal is to reduce pain, restore function, and prevent long-term damage to the shoulder joint. The treatment plan will be tailored to the individual’s needs and the severity of the condition.

1. Conservative Treatment Options

• Rest and Activity Modification: Initially, it is important to rest the shoulder and avoid activities that exacerbate the pain, particularly overhead movements. Modifying daily activities to prevent further strain on the shoulder can help reduce symptoms.

   

• Physical Therapy: Physical therapy is a cornerstone of treatment for shoulder impingement. A trained physical therapist will guide the patient through exercises designed to improve strength, flexibility, and scapular stability. Strengthening the rotator cuff muscles and improving posture can help alleviate pressure on the tendons.

   

• Ice and Anti-inflammatory Medications: Applying ice to the affected shoulder can help reduce inflammation and alleviate pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) can also be used to manage pain and swelling.

   

• Corticosteroid Injections: In some cases, corticosteroid injections may be recommended to reduce inflammation and provide short-term relief from pain. These injections are typically used when other conservative treatments are not effective.

   

2. Surgical Treatment Options

If conservative treatments fail to alleviate symptoms, or if the impingement is severe and causing significant damage to the rotator cuff, surgery may be necessary. The two most common surgical procedures for shoulder impingement are:

• Arthroscopic Subacromial Decompression: This minimally invasive surgery involves using a small camera (arthroscope) to remove or trim the bursa and any bone spurs that may be narrowing the subacromial space. This procedure helps to create more room for the rotator cuff tendons, relieving the pressure and preventing further irritation.
• Rotator Cuff Repair: If there is a rotator cuff tear associated with the impingement, the orthopedic surgeon may recommend repairing the tendon. This is typically done arthroscopically and involves reattaching the torn tendon to the bone.

Regain Your Well-Being with Dr. Berkman’s Treatments

Shoulder impingement is a common cause of shoulder pain that can significantly impact daily life if left untreated. Fortunately, with early diagnosis and appropriate treatment, most patients can recover and return to their normal activities. Whether through conservative methods like physical therapy or more advanced interventions like surgery, the team at Eric Berkman Orthopedic Surgeon can help guide patients through their recovery journey, providing the expertise needed to restore shoulder function and reduce pain.

If you have any questions or concerns, schedule an appointment with Eric Berkman, MD through this link.