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Shoulder impingement

Shoulder impingement is also known as rotator cuff tendinitis. It occurs when the rotator cuff tendons rub against (or impinge) on the shoulder blade, which causes pain and irritation.

Shoulder Impingement Causes and risk factors

This condition is common in young athletes, especially for tennis players, baseball players, and swimmers. It is also common for those with occupations that require repetitive overhead movement, such as painting or construction. Several factors can contribute to the development of shoulder impingement, including:

  • Repetitive overhead activities: People who engage in repetitive overhead movements or activities that involve raising the arm, such as swimming, tennis, or weightlifting, are at a higher risk of developing shoulder impingement.
  • Poor posture: Rounded shoulders or forward head posture can alter the alignment of the shoulder joint, increasing the likelihood of impingement.
  • Shoulder instability: Individuals with shoulder instability, where the shoulder joint is loose or prone to dislocation, may experience impingement due to the abnormal movement of the humeral head within the joint.
  • Bone abnormalities: Certain anatomical variations, such as the shape of the acromion (a bony process of the shoulder blade), can contribute to the narrowing of the subacromial space and impingement.
  • Aging: As we age, the structures in the shoulder can degenerate, including the tendons and bursa. This degeneration can increase the risk of impingement.
  • Trauma or injury: A previous shoulder injury or trauma, such as a dislocation or fracture, can lead to structural abnormalities or inflammation that predispose an individual to impingement.

These factors increase the risk of developing shoulder impingement, but they may not always directly cause the condition. A comprehensive evaluation by a healthcare professional is essential to determine the underlying causes and provide appropriate treatment.

Shoulder Impingement Symptoms

Shoulder impingement can cause a range of symptoms that typically involve pain and limited range of motion in the affected shoulder. Common symptoms of shoulder impingement include:

  • Shoulder pain: The most common symptom of shoulder impingement is pain, which is often felt on the front or side of the shoulder. The pain may be dull and aching or sharp and intense. It can worsen with certain movements, especially when raising the arm overhead or reaching behind the back.
  • Painful movements: Activities that involve raising the arm or reaching across the body can trigger or worsen the pain. Pain may also be experienced during activities like lifting, throwing, or even simple tasks such as reaching for objects on high shelves.
  • Weakness: Shoulder impingement can cause weakness in the affected shoulder, making it difficult to perform certain movements or lift objects. Weakness may be particularly noticeable when trying to lift the arm against resistance or when performing tasks that require strength.
  • Limited range of motion: Impingement can restrict the normal range of motion in the shoulder joint. You may experience difficulty in fully raising the arm, rotating it, or reaching behind the back. Activities like putting on clothes, combing hair, or fastening a bra may become challenging.
  • Shoulder stiffness: Impingement can lead to shoulder stiffness, making it feel tight and difficult to move the joint freely. This can affect daily activities and result in decreased mobility.

Treatment for Shoulder Impingement

Treatment for shoulder impingement typically begins with conservative measures and may progress to surgical intervention if symptoms persist. Conservative options include rest, anti-inflammatory medications, cortisone injections, and physical therapy. Resting the shoulder helps promote healing and reduces irritation, while anti-inflammatory medications help reduce pain and inflammation. Cortisone injections deliver powerful anti-inflammatory medication directly to the joint for temporary relief. Physical therapy plays a vital role in strengthening the shoulder muscles and improving mechanics through tailored exercises and manual therapy techniques.

If conservative treatments do not provide sufficient relief, surgical intervention may be considered. Arthroscopic surgery is the most common approach, involving small incisions for the insertion of a camera and surgical instruments. The surgeon removes inflamed tissues and may trim the acromion bone to create more space in the joint. In some cases, an open surgical technique with a larger incision may be chosen to directly access the joint and address impingement or structural abnormalities. Post-surgical rehabilitation, including physical therapy, is crucial to restore strength, range of motion, and function to the shoulder joint gradually.

It’s important to consult with a healthcare professional to determine the most appropriate treatment plan for shoulder impingement based on individual factors such as symptom severity, underlying causes, and overall health.