Shoulder Impingement – Diagnosis and Treatment
What is Shoulder Impingement?
Shoulder impingement is responsible for roughly half of all shoulder pain seen by orthopedic surgeons, and is often seen in those who spend a lot of time performing overhead movements such as swimmers and construction workers. Impingement involves the swelling and trapping of your rotator cuff tendon as it rubs and gets caught between your humerus (long upper arm bone) and acromion.
The acromion is an extension to the top part of your shoulder blade, and the gap between the acromion and your rotator cuff muscles narrows when you lift your arms above your head. With any further narrowing of this space (known as the subacromial space) you can suffer from pain, swelling, and stiffness. These symptoms can be caused by:
- Rotator cuff tendonitis – irritation of your rotator cuff tendons (usually of the supraspinatus muscle) as they rub against your acromion
- Subacromial bursitis – inflammation of the fluid filled sac sitting under the acromion which normally helps to lubricate your shoulder movements
- Impingement – trapping of your tendon as it gets caught in the narrow subacromial space
Shoulder impingement often comes on gradually, causing sudden pain when you lift your arm and eventually giving you pain all the time. Causes of shoulder impingement include:
- Shoulder injuries such as rotator cuff injuries and shoulder dislocation
- Sports that involve repetitive overhead movements such as swimming, baseball, and tennis
- Jobs that require repetitive overhead movements such as construction workers, painters, or electricians
- Thickening or calcification of your shoulder ligaments, usually due to age
- Bony spurs in your shoulder joint due to arthritis or anatomical variations
Some people get a condition called internal shoulder impingement (also known as posterior shoulder impingement). This is a separate condition that occurs in those that take part in activities that make you reach your arm all the way back – like when a baseball pitcher reaches their arm back before throwing. Internal shoulder impingement involves the glenohumeral joint rather than the acromial space.
Do I Have Shoulder Impingement?
If you get pain in your shoulder when you try to lift your arms above your head, you might have shoulder impingement. The pain often comes on gradually, then worsens over weeks to months.
Symptoms of shoulder impingement include:
- Sudden pain in your shoulder when you lift your arms up
- As the inflammation worsens, constant pain at rest and at night
- Stiffness in your shoulder movements
- Difficulty reaching behind your back, like when getting something out of your back pocket
- Weakness and loss of strength in your shoulder
- Difficulty sleeping on your affected shoulder at night
Often once the pain starts you end up in a vicious cycle. The impingement causes swelling, which narrows the subacromial space further, which then causes more swelling. If you are experiencing these symptoms, it’s important that you visit a local orthopedic surgeon – the sooner it’s treated, the quicker you’ll recover.
How is Shoulder Impingement Diagnosed?
When you see Dr. Mehta, she will examine the pain and movement in your shoulder joint. She will determine possible causes of pain, and if there are any serious symptoms which require urgent attention.
Following physical examination, your doctor may arrange for further testing including an x-ray and a shoulder MRI. These tests help to identify the cause of your pain and rule out any serious injuries which may require an injection or surgery.
How is Shoulder Impingement Treated?
The aim of treatment in shoulder impingement is to reduce the inflammation and swelling – therefore reducing your pain and ending the vicious cycle. If you are still in the early stages your doctor might suggest:
- Resting your shoulder
- Avoiding overhead activities and movements that cause pain
- Regularly placing an ice pack on your shoulder
- Shoulder impingement stretches and exercises
- Anti-inflammatory medication
If your shoulder impingement is severe, or isn’t getting better despite treatment, Dr. Mehta might advise:
- A structured physical therapy program
- Cortisone injection to reduce swelling
- Shoulder impingement surgery
Shoulder impingement surgery (subacromial decompression) involves removing a bone spur and expanding the narrowing in your subacromial space, making it easier for your rotator cuff tendons to move freely. This can often be done through shoulder arthroscopy which is minimally invasive – leaving a small scar and improving recovery time compared to an “open” surgery.
Following treatment for your shoulder impingement, full recovery may take weeks or months – though you’ll notice improvements after 2-4 weeks. If you have undergone shoulder impingement surgery, you may be required to wear a sling for the following weeks.
How Resilience Orthopedics Can Help
Dr. Pamela Mehta, MD – Orthopedic Surgeon in San Jose, California
Dr. Pamela Mehta is an orthopedic surgeon and a specialist in shoulder conditions including shoulder impingement. She can rule out alternative diagnoses and make sure you get the best possible treatment plan for a swift recovery. Dr. Mehta offers a concierge service and treats you holistically, rather than just fixing your joints. She listens to your concerns and takes time to explain how your condition will affect you.
Resilience Orthopedics is based in San Jose, California. To find a shoulder surgeon and make sure you get the right diagnosis and treatment the first time, get in touch and begin your journey to recovery.