What Is Shoulder Impingement Syndrome?
The shoulder is a ball-and-socket joint, like the hip. Unlike the hip, the shoulder is a meeting of three bones–the upper arm (humerus), collarbone (clavicle) and shoulder blade (scapula)–and is the most mobile joint in the body. Because there are so many moving parts–the bones, plus all the muscles, tendons, ligaments and other tissues holding them together–there exists a high potential for problems.
One of the most common shoulder problems is rotator cuff impingement. It’s a specific type of condition of the rotator cuff, the collection of muscles and tendons that attach the humerus to the clavicle and allow it to move.
When an injury to the shoulder occurs, either acutely or over time, the tissues of the rotator cuff swell and begin to degrade. These swollen, damaged tissues can then become trapped between the humerus and a bony outcropping of the shoulder blade known as the acromion process.
Symptoms and Causes
Pain, especially when raising the arm overhead or behind the back, is the main symptom of shoulder impingement. Tissues affected include the rotator cuff tendons, which is a condition called tendinitis or tendinopathy, and the shoulder bursa–a fluid-filled sac that allows for smooth movement of the shoulder–in a condition called bursitis.
Anyone whose job or activities involve repetitive overhead movements is at risk for shoulder impingement. People at risk include:
- Shelf stockers
- Tennis players
- Volleyball players
A doctor will conduct a physical exam, both watching the patient move the arm and manipulating the arm, while assessing pain. Imaging studies are not always necessary, but ultrasounds and X-rays may be useful to confirm a diagnosis.
Surgery is rarely initially recommended for shoulder impingement. When symptoms start, the best way to treat them is with rest, ice and over-the-counter pain medication like acetaminophen or ibuprofen. Steroid injections may also help to relieve symptoms.
Physical therapy and rehabilitation is the main form of treatment for shoulder impingement. The goals of physical therapy are to increase the range of motion and to strengthen and stretch the shoulder muscles. If poor sports technique–for example, throwing a ball inefficiently–caused the impingement, the proper way to perform the activity will probably also be part of the therapy.
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