Shoulder impingement, commonly known as impingement syndrome, swimmer’s shoulder or rotator cuff tendonitis, is the condition of inflammation of the tendons of the shoulder joint. It is one of the most common causes of pain in the adult shoulder.
Impingement of the shoulder can occur when the tendons of the rotator cuffs grind against the shoulder bone known as the acromion.
Causes
Shoulder impingement results from pressure on the rotator cuff from part of the shoulder blade (scapula) as the arm is lifted. It is more likely to occur in young and middle aged people who engage in physical activities that require repeated overhead arm movements.
The pain may be due to a “bursitis” or inflammation of the bursa overlying the rotator cuff or a “tendonitis” of the cuff itself. In some circumstances, a partial tear of the rotator cuff may cause impingement pain.
If you have a job or hobby that involves repetitive arm movements above shoulder level, this may cause shoulder impingement to worsen and cause pain. When shoulder impingement starts to cause damage to the rotator cuff, it is important to seek out a shoulder impingement treatment.
Impingement syndrome may worsen if you have or develop bone spurs in the shoulder, which can reduce the space under the shoulder blade. This reduction in space results in more contact, friction, and shoulder impingement, which can begin to cause pain or worsen existing symptoms.
Symptoms
Shoulder impingement symptoms include aches and pain in the shoulder. As shoulder impingement progresses, it may begin to cause pain in the shoulder when raising the arm to or above shoulder level. A symptom of impingement syndrome is also a sharp pain when attempting to move your arm behind your lower back. Joint stiffness is also a common impingement syndrome symptom. If you experience arm weakness or have trouble lifting your arm, you may have a torn rotator cuff.
Diagnosis
Diagnosis involves physical examination by the doctor where in the doctor checks for the possible range of movements with the affected shoulder. X-rays and MRI scans may be ordered to see the injury and inflammation.
Conservative Treatment Options
Shoulder impingement can be treated with rest, ice packs, anti-inflammatory drugs, and avoiding activities involving the shoulder. Physical therapy may be advised to strengthen the muscles and steroid injections may be given if pain persists.
Surgery
Open Shoulder Impingement Surgery
During open shoulder impingement surgery, an incision is made where bone can be removed from. These incisions are typically placed over the top of the shoulder. Open shoulder impingement surgery removes any existing bone spurs from the shoulder, as well as part of the acromion. The rough ends of the bone will then be gently smoothed. With open shoulder impingement surgery, patients may be required to stay in the hospital for a few days following surgery.
Shoulder Resection Arthroplasty
Along with shoulder impingement, the AC joint may become damaged due to arthritis. To treat AC joint arthritis, Dr. Paley will remove the end of the shoulder during shoulder impingement surgery. This procedure is known as shoulder resection arthroplasty, which involves removing the last inch of the shoulder bone. Following impingement syndrome surgery, scar tissue will form in the space between the shoulder blade and acromion, which creates a joint-like structure. Shoulder resection arthroplasty is designed to minimize bone-to-bone contact to reduce pain.
Acromioplasty
Acromioplasty aims to increase the overall space between the tendons of the rotator cuff and the acromion. Because acromioplasty alleviates pressure from the tissues below the acromion, it is also referred to as subacromial decompression surgery. During acromioplasty, Dr. Paley will remove bone spurs that are disturbing or damaging the bursa or rotator cuff. A portion of the shoulder blade may also be removed during acromioplasty to provide more space for the tendons. If your shoulder blade is naturally tilted downward, additional portions of the shoulder blade may need to be removed. The term acromioplasty comes from the surgical cutting and reshaping of the shoulder blade during subacromial decompression surgery.
Arthroscopic Shoulder Impingement Surgery
Some cases of impingement syndrome can be treated with minimally invasive arthroscopic shoulder impingement surgery. An arthroscope is a tiny camera at the end of an endoscope that can provide an internal view of the body. The images gained from the endoscope can be displayed on a screen, allowing Dr. Paley a live view of the shoulder joint. The arthroscope is placed through a small incision. Additional small incisions will be made to insert surgical instruments to perform the shoulder impingement surgery. Patients who undergo arthroscopic shoulder impingement surgery generally recover more quickly because it is a less invasive procedure.