Impingement syndrome describes pain in the subacromial space (the space between the Rotator Cuff tendon and the acromion bone above) when the humerus is raised or rotated inwards. The tendon and bursa become trapped and pinched between the tip of the acromion bone and the humerus bone. The syndrome causes gradual degeneration and micro-tearing of the rotator cuff. This can eventually lead to a full Rotator Cuff tear.

Shoulder impingement is also called swimmer’s shoulder, tennis shoulder, or rotator cuff tendinitis. It is the condition of inflammation of the tendons of the shoulder joint caused by motor vehicle accidents, trauma, and while playing sports such as tennis, baseball, swimming and weightlifting.

Individuals with shoulder impingement may experience severe pain at rest and during activities, as well as weakness of the arm and difficulty in raising the hand overhead. X-rays and MRI scans show the injury and inflammation.

Shoulder impingement can be treated with rest, ice packs, anti-inflammatory drugs, and avoiding the activities involving the shoulder. Physical therapy may be advised to strengthen the muscles, and steroid injections may be given if pain persists. Arthroscopic shoulder surgery is recommended if the rotator cuff tendons are torn and to remove bone spurs in the shoulder.

STAGES OF IMPINGEMENT:

STAGE I –

  • Edema and Hemorrhage of the tendon
  • Narrow space for the Rotator Cuff caused by bone spurs

STAGE II –

  • Chronic inflammation (or repeated episodes of impingement) leads to scarring and thickening of the rotator cuff tendon
  • At this stage activity modification can no longer reverse the process
  • Usually between ages 25-45 years old, but duration of pain is more important than age
  • Symptoms interfere with sleep and work. They may progress to interfere with activities of daily living.
  • Narrow space for the Rotator Cuff caused by shoulder bone spurs

STAGE III –

  • Rotator Cuff Tears, biceps tendon rupture and radiologic changes in the bone
  • Prolonged, failed conservative treatment
  • Usually over the age of 40
  • Rotator Cuff weakness
  • May have associated AC (acromio-clavicular) joint arthritis
  • Narrow space for the Rotator Cuff caused by bone spurs

TREATMENT:

Non-Surgical Treatment: This involves rest, non-steroidal anti-inflammatory medicine and physical therapy. The goal of physical therapy is to restore normal range of motion, stretch out the tightness and build strength in the rotator cuff tendons. Steroid injections may be used cautiously.

ARTHROSCOPIC SURGICAL TREATMENT:

This is a minimally-invasive procedure that involves small puncture wounds and scope. The goal is to recreate space for the rotator cuff to glide and move. Inflamed bursa surrounding the rotator cuff tendon are removed, and an Acromioplasty (also called Subacromial Decompression) is performed. This is the removal of the bone spur and any other protruding bone. At the same time, it may be beneficial to remove an area of arthritis in the AC joint.

References:

http://www.ncbi.nlm.nih.gov/pubmed/2302880

http://www.ncbi.nlm.nih.gov/pubmed/8472446

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