Impingement Syndrome
Also known as: rotator cuff
impingement, shoulder impingement syndrome
See also:
Rotator
Cuff Injury
What is it?
Impingement syndrome is a condition that affects the
rotator cuff, causing shoulder pain. The rotator cuff
is a group of muscles and tendons that secures the arm
to the shoulder joint and allows the arm to rotate.
Who gets it?
Impingement syndrome is more likely to occur in
people who engage in physical activities that require
repeated overhead arm movements, such as tennis, golf,
swimming, weight lifting, or pitching a ball, or whose
profession requires repeated overhead lifting.
Impingement syndrome can also occur in people with
rheumatoid arthritis.
What causes it?
Repeated movement of the arm overhead can cause the
rotator cuff to contact the outer end of the shoulder
blade where the collarbone is attached, called the
acromion. When this happens, the rotator cuff becomes
inflamed and swollen, a condition called tendonitis.
The swollen rotator cuff can get trapped and pinched
under the acromion. All these conditions can inflame
the bursa in the shoulder area. A bursa is a
fluid-filled sac that provides a cushion between a bone
and tissues such as skin, ligaments, tendons, and
muscles. An inflammation of the bursa is called
bursitis.
What are the symptoms?
Impingement syndrome results in shoulder pain that
can extend from the top of the shoulder to the elbow.
In the beginning, the pain occurs whenever the arm is
raised over the head. While the pain may not occur when
the arm is at rest, it may flare up when sleeping
because of pressure on the shoulder area. With time and
repeated motion, the arm becomes weak, with little
range of motion. Eventually, tiny tears in the fibers
of the rotator cuff can progress to a larger tear in
the tendon or even pull the tendon off the bone.
Impingement syndrome is usually accompanied by shoulder
tendonitis and bursitis.
How is it diagnosed?
To diagnose impingement syndrome, your doctor will
ask about your physical activities and will examine
both shoulders. He or she will check for tenderness in
the shoulder and will test your range of motion by
having you move your arm to a variety of positions. He
or she will also perform strength tests, such as
pressing down on your arm as you try to keep it in a
raised position with the elbow bent. Diagnostic tests
may include x-rays to check the condition of the bones
in the shoulder area, or magnetic resonance imaging or
ultrasound scans to look for tears in the rotator cuff.
Shoulder pain can sometimes be caused by a problem with
the cervical spine, which is in the neck area. Your
doctor will check this area to rule out this cause. If
your doctor suspects impingement syndrome, he or she
may inject a small amount of pain relieving medication,
such as lidocaine hydrochloride, into the space under
the acromion. Pain relief from this injection usually
indicates impingement syndrome.
What is the treatment?
Treatment for impingement syndrome begins with rest,
ice packs, and anti-inflammatory medications.
Ultrasound therapy may also be recommended to stimulate
the tissues and improve blood flow. After the pain is
gone, you will be able to begin stretching and
strengthening exercises, as recommended by your doctor.
Most patients see an improvement within 6 to 12 weeks.
Some patients also benefit from a limited number of
corticosteroid injections into the space under the
acromion to reduce inflammation. If this treatment is
not successful within 6 to 12 months, your doctor may
recommend surgery to release the ligament, followed by
physical therapy to gradually increase your range of
motion. You may need to modify your physical activities
to reduce the possibility of a relapse.
Self-care tips
You can prevent impingement syndrome by avoiding the
type of repetitive motions that irritate the rotator
cuff. If you do engage in physical activities that
require these types of motions, follow a regular
program of strengthening exercises, using light
weights, to keep the rotator cuff muscles strong.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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