Impingement syndrome, also known as shoulder impingement, is a common cause of shoulder pain that occurs when soft tissues in the shoulder get compressed or "pinched" between the humerus (upper arm bone) and the acromion (part of the shoulder blade). This condition can develop gradually over time from repetitive motions that stress the tendons and bursae (fluid-filled sacs) in the shoulder joint. In this article, we will discuss the causes, symptoms, diagnosis and treatment options for impingement syndrome.
Causes of Impingement Syndrome
The main causes of impingement syndrome include:
Repetitive overhead activity: Jobs or sports that involve frequent overhead motions like lifting, throwing or serving can place excess stress on the rotator cuff tendons and bursae over time. Common examples are swimming, tennis, volleyball and construction work.
Forward shoulder posture: Having rounded shoulders from poor posture can predispose the tissues in the shoulder joint to impingement when lifting the arm overhead or behind the back.
Shoulder injury or deformity: Previous injuries like dislocations, fractures or tears in the rotator cuff tendons can lead to scarring and deformity that causes impingement. Bone spurs in the acromion can also develop.
Genetics: Some people are simply born with a more narrow subacromial space that makes them prone to impingement.
Age-related changes: As we age, the tissues in our body lose elasticity. This makes impingement more likely to occur from daily activities in older individuals.
Symptoms of Impingement Syndrome
The main symptoms of impingement syndrome include:
- Shoulder pain that gets worse when lifting the arm overhead or behind the back. Pain may radiate down the arm.
- Tenderness over the front or top of the shoulder.
- Difficulty sleeping on the affected shoulder.
- Weakness when lifting objects or reaching overhead.
- Catching, clicking or grinding sensation in the shoulder joint.
- Swelling over the shoulder.
The symptoms tend to worsen gradually over time if left untreated. In severe cases, weakness and restricted range of motion can develop as surrounding tissues become increasingly damaged and inflamed.
Diagnosing Impingement Syndrome
To diagnose impingement syndrome, doctors will first take a detailed medical history and perform a physical examination of the shoulder. Some tests that may be used include:
- Range of motion tests: Restricted internal or external rotation can indicate impingement.
- Impingement signs: Tests like the Jobe, Neer or Hawkins sign recreate impingement by moving the arm in certain positions to elicit pain.
- Special shoulder tests: Tests like the empty can or lift-off help check for weakness from rotator cuff damage.
- Imaging studies: X-rays can detect bone deformities like spurs. Ultrasound and MRI scans provide detailed images of soft tissues to check for tears or inflammation.
- Injections: Diagnostic injections of corticosteroids or anesthetics into the subacromial bursa can help confirm impingement as the pain source.
The diagnosis is usually made based on the combination of physical examination findings and test results. Other potential causes of shoulder pain need to be ruled out as well.
Treatment Options for Impingement Syndrome
Non-surgical options are usually tried first for impingement syndrome:
Rest and Activity Modification: Reducing activities that aggravate pain, especially overhead motions, is important. Proper strengthening can be done once inflammation subsides.
Physiotherapy: Heat or ice therapy, ultrasound, electrical stimulation and therapeutic exercises help reduce pain and inflammation while improving shoulder mobility and strength.
NSAIDs and Pain Relievers: Over-the-counter anti-inflammatory drugs (NSAIDs) and pain relievers provide temporary symptom relief.
Cortisone Injections: Injections of corticosteroids into the subacromial bursa help reduce inflammation and pain. Multiple injections over months may be needed.
Orthotics and Bracing: Shoulder supports can be used to rest the joint and limit impingement during recovery.
Platelet-Rich Plasma (PRP) Therapy: PRP injections use the patient's own growth factors to promote healing of inflamed or damaged tissues.
Surgery to Address Impingement
If non-surgical management fails after 3-6 months, surgery may be considered for persistent, severe cases of impingement syndrome:
- Arthroscopic shoulder decompression: This minimally invasive surgery clears space under the acromion by shaving bone spurs or tissue. Rotator cuff repairs can also be done simultaneously.
- Acromioplasty: The outer tip of the shoulder blade is surgically reshaped to widen the subacromial space and relieve impingement.
- Distal clavicle excision: Removes the end of the collarbone for better shoulder mechanics in individuals with extra-bone formation in that area.
Outcomes after surgery are generally good, with over 80% of patients experiencing significant pain relief and functional improvement. However, recovery may take weeks due to post-surgical stiffness. Ongoing rehabilitation is important long-term.
Conclusion
In summary, impingement syndrome is a common cause of shoulder pain that results from mechanical compression of tissues in the subacromial space. Lifestyle modifications and physiotherapy provide relief for mild-moderate cases. Surgery is a good option when conservative measures fail to significantly improve severe, persistent symptoms over a reasonable trial period. With proper treatment and rehabilitation, most individuals can successfully manage this overuse shoulder condition.
No comments:
Post a Comment