Shoulder Impingement Syndrome

Impingement syndrome is the most common cause of shoulder pain. If you have impingement syndrome, you will likely experience pain when you raise your hand above your shoulder or out to the side. It can also cause pain and stiffness when you reach behind your back, or try to reach toward your other shoulder. In severe cases, the shoulder pain is more bothersome at night and can wake you up when you roll onto your side. You may feel pain in one or two spots at the front of your shoulder or over your entire shoulder. You may also feel pain radiating down your arm or up toward your neck.

What causes impingement syndrome?

Every time we move our shoulders, the shoulder muscles pull on the rotator cuff tendons. These tendons can wear out, just like any other part of the body, and when they do, they can start to cause pain. The rotator cuff tendon has a soft tissue bursa (a small pouch) that protects the tendon from injury. If that bursa becomes inflamed or worn out, the tendon can become damaged and cause pain. Pain can also be caused by bone spurs growing over the rotator cuff tendons. This is part of the normal aging process, but it is less common than damage to the bursa. Such bone spurs can rub against the bursa and irritate the rotator cuff tendons. The pain occurs when the arm is raised to shoulder height because that is the position where the rotator cuff is strained the most.

How do you treat impingement syndrome?

The first step in treating impingement syndrome is to try to understand its cause. Repetitive physical activities can injure the rotator cuff as well as recurring shoulder positions in which the arm is held overhead or to the side. These activities and positions must be avoided so that the tendon can rest and heal.

The rotator cuff can also wear out when it is placed under abnormal stress. This can happen if you put too much stress on your rotator cuff when lifting heavy things.

Learning the proper technique for lifting objects, with the correct posture of the back and shoulder blades, will take stress off of the injured rotator cuff tendon and allow it to heal. Once the tendon is no longer irritated and inflamed, the muscles attached to the rotator cuff tendon can be exercised.

Physical Therapy For Impingement Syndrome

Physical therapy is beneficial for shoulder pain because it strengthens the muscles that we often neglect during our normal activities and therapy teaches us how to use every muscle properly.

The shoulder depends on a lot of other muscles in the body, including those in the hips, abdomen and back for core strength. If those muscles are not conditioned, then the shoulder muscles have to work twice as hard to lift the same amount of weight.

The shoulder blade is the platform for the rotator cuff muscles. If the should blade is not held in the correct position, then the rotator cuff muscles do not have the leverage needed to move the arm, and the body compensates by using the rotator cuff muscles twice as much. This is easy to do occasionally, but if you have to do it all day, your body loses the ability to compensate, and eventually the tendons are injured.

Steroid Injections For Impingement Syndrome

Another treatment option for impingement syndrome is steroid injections into the inflamed rotator cuff bursa. These injections are much less painful than those given in other areas of the body, like the foot or hand.

Although the benefit of injections is most often temporary, in the case of impingement syndrome, this is exactly what is needed. The steroid temporarily covers up the pain, allowing you to get treatment through physical therapy. Proper sleep is also important when treating an injured rotator cuff, so if steroid injections help you sleep, it is beneficial. Steroids have side effects, which include tendon degeneration, but this usually occurs after multiple injections. One or two injections rarely cause tendon tears in the shoulder.

Surgery For Impingement Syndrome

If rest, activity modification, and physical therapy do not cure the pain from impingement syndrome, then surgery may be needed. The surgery can be performed with an arthroscope, an instrument with a tiny camera on the end that can be inserted through small incisions around the shoulder. This type of surgery makes the recovery relatively simple. Your surgeon will look inside the shoulder joint to make sure all the other structures are healthy, then remove the injured rotator cuff bursa and any bone spurs that may be irritating the rotator cuff.

The success of the surgery depends on the healing of the rotator cuff, which will take up to 6 months. The rehabilitation process includes a few weeks of rest immediately after the surgery, as well as physical therapy once the pain from the surgery subsides.

If you experience temporary pain relief from an injection prior to surgery, you'll likely have greater pain relief after surgery. The surgery will most likely eliminate any constant, aching pain and night pain, but patients may still have brief pain associated with overhead activity.