Impingement Syndrome

What is impingement syndrome?

Impingement syndrome is a precondition for many common shoulder problems, including arthritis, bursitis, tendonitis, and rotator cuff tendon injuries. The tendons of four muscles form the rotator cuff, which come together to stabilize the shoulder joint. These tendons run beneath the bony point of the shoulder, called the acromion. These tendons keep the upper arm bone (humerus) fitted tightly in the socket of the shoulder blade, when the arm is raised. The space between the acromion and the rotator cuff can become narrowed, resulting in discomfort or pain when you raise your arm above your head.

What are the symptoms of impingement syndrome?

The most common complaint in impingement syndrome is pain. The pain may be sharp and intermittent early on, but as the impingement progresses, the pain may become a dull, constant ache. Pain may occur at night, as a result of inflammation and swelling that has occurred throughout the day as the shoulder is being used. Other symptoms include fatigue, a sensation that the shoulder is "catching" when being moved, a decrease in athletic performance, stiffness, or weakness.

What causes impingement syndrome?

Impingement syndrome is usually caused by overuse of the shoulder. The initiating event may be minor and may not be remembered as painful. Some individuals have an impingement syndrome as a result of instability of the shoulder joint, caused by rotator cuff tendons that do not hold the humerus tightly enough in its joint space.

How would my physician diagnose impingement syndrome?

Your physician will ask you about your symptoms, your activities/work, and other aspects of your medical history. In the office, specific maneuvers in the physical examination can be performed to test if there is impingement at the shoulder. Your physician may perform a special test for impingement in which a local anesthetic is injected into the shoulder, which will relieve the pain if the source is truly impingement in nature. Your physician may wish to obtain X-rays, arteriogram (an x-ray taken with a contrast agent injected into the joint space) or MRI's (magnetic resonance imaging, a special type of x-ray) to help confirm the diagnosis.

What are my options for treatment?

Impingement syndrome is most often treated by your physician conservatively (non-surgically) first, incorporating the use of non-steroidal anti-inflammatory drugs (NSAID's), proper warm-up before activities, strengthening and stretching exercises, and "active rest". Active rest involves modifying athletic activities so that there is less inflammation and swelling occurring at the shoulder joint.

For those individuals that continue to experience pain and a decrease in quality of life or ability to perform work as a result of impingement syndrome, surgery may be an option. The surgery may be arthroscopic (performed with a pencil-thin fiber optic camera and surgical tools inserted through small incisions in the skin; often an outpatient procedure) or open surgery, or a combination of both. Ask your orthopaedic surgeon which surgery might be right for you, as there are many factors that go into each individual case.

What are the advantages of surgical treatment?

Correcting impingement syndrome also means you are less likely to be subject to chronic bouts of impairment from related conditions such as bursitis, arthritis, or tendonitis.

What will my recovery be like after surgery?

After surgery, your arm will be protected with a sling, an immobilizer, or a splint or cast. Often, physical therapy is started the day after surgery. A therapist will show you exercises to cut down on the amount of stiffness and swelling that may occur after surgery. Though you will be encouraged to move your fingers, hands and elbow gently, you should avoid lifting anything at first, so the healing process will not be hampered. Icing the sore area can also help prevent inflammation.

Physical therapy in the weeks following the surgery will involve strengthening and stabilizing the tendons of the rotator cuff to decrease the possibility of impingement symptoms or other related problems recurring in the upper arm or shoulder.

Improvement to the shoulder is determined not only by surgery but also by your general condition and rehabilitative effort. In many cases, the tendons and muscles of the shoulder have been weakened from prolonged misuse or degeneration, and strengthening them will require a gentle, steady process of changing habitual ways of moving your arm. Keeping in mind that it is likely to be several months before you achieve maximal results, you can almost always look forward to a more mobile, pain-free joint.

Nancy Yen MS4