Orthopedic Surgery, Shoulder Surgery
October 14, 2020
Symptoms & Solutions: Shoulder Impingement
Shoulder impingement is a condition that affects the function of the shoulder joint, primarily involving the rotator cuff and the muscles and tendons in the area.
Also called shoulder impingement syndrome, it refers to the irritation of tendons or bursa (small fluid sacs) that can occur when rubbing against the shoulder blade.
Shoulder impingement is usually caused by repetitive overhead activities such as lifting, painting, and sports like tennis or swimming. Joint abnormalities can also contribute to shoulder impingement.
Symptoms of Shoulder Impingement
The main symptom of shoulder impingement is consistent pain that affects daily activities. This pain can be quite severe, particularly when attempting to move your arm over your head. It generally develops gradually over days or weeks, building slowly. It will be more severe when you use your arm for overhead throwing, lifting, or swinging.
The pain may be focused on the front or outside of the shoulder area. There may be no pain when your arm is at your side or directly above your head: the most prevalent pain is within the 30-degree arc to the side and slightly above your shoulder joint. You may also experience weakness in the joint, which can increase over time if the impingement isn’t properly treated.
Diagnosing Shoulder Impingement Syndrome
The orthopedic surgeons at Arkansas Surgical Hospital can assess your shoulder to determine if you may have shoulder impingement syndrome. They can then advise you on the best treatment options for your specific case.
To determine whether your shoulder is impinged and the severity of your condition, several steps will be taken. These typically include:
- Taking a patient history. Be sure to describe your symptoms accurately, how long you’ve had them, and the nature of the pain.
- Physical examination of the shoulder. This can include an assessment of your range of movement, tenderness, and swelling.
- X-rays. These can help reveal abnormalities such as bone spurs.
- MRIs. These may show inflammation, soft tissue damage, or tears in the rotator cuff or bursae.
Once these tests are done, your doctor can determine what type of shoulder impingement you have and develop the appropriate course of treatment to help you heal.
Types of Shoulder Impingement
There are two main kinds of shoulder impingement: external and internal.
- External shoulder impingement can be either primary or secondary, depending on whether it is caused by an abnormality in the shoulder joint (primary) or poor stabilization of the shoulder blade (secondary).
- An internal shoulder impingement usually happens when athletes are required to repetitively throw (such as pitching a baseball or throwing a javelin). It is also seen in house painters and other workers who must reach above their shoulders and use repetitive, arcing movement.
Non-Invasive Shoulder Impingement Treatments
If you have a shoulder impingement in any form, the first forms of treatment recommended will be the least invasive. These generally include anti-inflammatory medications—such as naproxen sodium, ibuprofen, and aspirin—for six to eight weeks.
If your shoulder impingement symptoms don’t respond well to oral medications, cortisone injections may be an alternative. These are potent anti-inflammatory drugs that are injected directly into the affected area. They are incredibly effective but cause side effects over time, which your doctor will discuss with you before treatment.
Daily stretching exercises or regular physical therapy can also help relieve shoulder impingement symptoms. The goal of treatment is to strengthen and stretch the muscles to reduce inflammation and relieve pain. Ice and massage may also be used. A physical therapist can demonstrate exercise and stretching techniques you can use at home.
Surgical Solutions for Shoulder Impingement
Non-invasive treatments for shoulder impingement should always be the first option pursued. However, if none of those work, surgery may be recommended to release the compression of soft tissues, restore range of motion, and relieve pain.
Subacromial Decompression Surgery
Subacromial decompression surgery involves removing bone tissue from the upper bone of the shoulder (the acromion). The surgeon will cut away part of the end and underneath the acromion to open up the subacromial space around the ball-and-socket joint. This allows more room for the tendons and tissues in the area to move. This is a useful option if your shoulder impingement has been caused by significant bone spurs or curved acromion bone growth.
During a bursectomy, the surgeon will remove any bursae that are inflamed and any scar tissue in the area. Then, new bursae can grow into the space to replace the removed tissue.
Rotator Cuff Repair Surgery
Rotator cuff surgery is the most extensive surgical intervention and is only done when the tendons have become fully or partially detached. Some indications that rotator cuff surgery may be an option for you include:
- Persistent pain that interferes with daily life
- Symptoms that have lasted more than six months
- A tear in the tendon larger than three centimeters
- Diminished shoulder function
- Significant weakness in the shoulder
- An acute or traumatic injury
If you and your doctor decide that surgery is the right option for you, the operation’s extent will vary. The most common surgery involves surgical reattachment of the tendon to the upper arm bone (humerus). If the tendon isn’t detached and is merely torn, it may only need to be trimmed.
Recovering from Shoulder Impingement Surgery
Recovery after surgery will take several months. For the first four to six weeks, you will wear a sling to immobilize the shoulder while the tendon and rotator cuff heal. After this, you will begin a passive exercise regime to strengthen your shoulder’s muscles and tendons and improve arm control. Expect full recovery to take up to six months.
Whether you have a mild shoulder impingement being treated with physical therapy or need rotator cuff surgery, you can improve your recovery odds and the results by keeping a few things in mind. You must be vigilant about doing everything your doctor, surgeon, and physical therapist instructs you to do at home. You need to get proper nutrition and adequate rest, avoid smoking, and make sure you do not take any medications improperly. If you have any questions, call your doctor and ask.
Do You Have an Impinged Shoulder?
If you have shoulder pain, our orthopedic surgeons will evaluate you to determine how severe your condition is and whether you have shoulder impingement syndrome. From there, you can discuss both surgical and non-surgical options to determine the best course of action. Contact Arkansas Surgical Hospital at (866) 273-1271 to schedule an appointment.