Shoulder Impingement
Shoulder impingement is a painful condition of the shoulder resulting from a structural narrowing of the subacromial space. It is primarily diagnosed by history and physical examination. The main-stay of treatment involves identification early before the onset of degenerative changes, physical therapy exercises to strengthen the shoulder girdle, and medicines to decrease inflammation.
What Are the Symptoms of Shoulder Impingement Syndrome?
The typical symptoms of impingement syndrome include difficulty reaching up behind the back, pain with overhead use of the arm and weakness of shoulder muscles.
If tendons are injured for a long period of time, the tendon can actually tear in two, resulting in a rotator cuff tear. This causes significant weakness and may make it difficult for the person to elevate their arm. Some people can have rupture of their biceps muscle as part of this continuing impingement process.
How Is Impingement Syndrome Diagnosed?
Diagnosis of impingement syndrome begins with a medical history and physical exam by your doctor. X-rays will be taken to rule out arthritis and may show changes in the bone that indicate injury of the muscle. Bone spurs or changes in the normal contour of the bone may be present. MRI is the gold standard to diagnose impingement syndrome wherein it can detect the space for the rotator cuff, bony spurs, rotator cuff inflammation or rotator cuff tendinitis and rotator cuff tears too.
How Is Shoulder Impingement Syndrome Treated?
Oral anti-inflammatory medications -- such as aspirin, naproxen, or ibuprofen, remain the most common treatment for impingement syndrome.
The medicines are usually given for one to two weeks since it can cause stomach irritation and bleeding if taken for a longer period of time.
We may refer you to a physical therapist who can demonstrate the exercises most effective in strengthening and stretching the shoulder muscles.
If you have persistent symptoms, despite the use of oral anti-inflammatory drugs, your doctor may consider a steroid injection. Cortisone is a potent anti-inflammatory medication, which should be used only when necessary because it can result in weakening of muscles and tendons if used repeatedly.
If symptoms persist or if significant weakness is present, then your doctor may perform an ultrasound, MRI or an arthrogram to rule out a rotator cuff tear. If the cuff is torn, surgery may be necessary to repair it.
The vast majority of people who have impingement syndrome are successfully treated with medication, stretching exercises, and temporary avoidance of repetitive overhead activity until the condition settles down.
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