Shoulder Impingement Syndrome

Overview:

Shoulder impingement syndrome is a common condition characterised by compression or pinching of the structures in the shoulder joint, particularly the rotator cuff tendons and subacromial bursa, when the arm is lifted or rotated. This impingement can lead to inflammation, pain, and restricted movement in the shoulder.

Anatomy:

The shoulder is a complex joint consisting of the humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone). The rotator cuff, a group of muscles and tendons, helps stabilise and move the shoulder joint. The subacromial bursa is a fluid-filled sac located between the rotator cuff tendons and the acromion, a bony prominence of the scapula.

Causes:

Several factors contribute to shoulder impingement syndrome, including:

1. Anatomical variations: Certain anatomical features, such as a hooked or curved acromion, may predispose individuals to impingement.
2. Overuse or repetitive activities: Activities involving repetitive overhead arm movements, such as swimming, throwing, or weightlifting, can strain the shoulder structures and lead to impingement.
3. Muscle imbalances: Weakness or tightness in the muscles surrounding the shoulder joint, particularly the rotator cuff and scapular stabilisers, can alter the mechanics of the shoulder and increase the risk of impingement.
4. Poor posture: Rounded shoulders or forward head posture can contribute to impingement by narrowing the subacromial space and reducing clearance for the rotator cuff tendons.

Symptoms:

Common symptoms of shoulder impingement syndrome include:

• Pain in the front or side of the shoulder, which may radiate down the arm.
• Pain with overhead activities or reaching behind the back.
• Weakness and loss of strength in the affected shoulder.
• Shoulder stiffness or limited range of motion, particularly when lifting the arm overhead.
• Pain at night, especially when lying on the affected side.

Diagnosis:

Diagnosing shoulder impingement syndrome typically involves a combination of:

• Medical history: Discussion of symptoms, onset, and aggravating factors.
• Physical examination: Assessment of shoulder range of motion, strength, and tenderness.
• Special tests: Specific manoeuvres, such as the Neer and Hawkins-Kennedy tests, may be performed to reproduce impingement symptoms and assess rotator cuff integrity.
• Imaging studies: X-rays, ultrasound, or MRI scans may be ordered to evaluate the bony and soft tissue structures of the shoulder joint and identify any structural abnormalities or signs of inflammation.

Treatment:

Treatment options for shoulder impingement syndrome aim to alleviate pain, reduce inflammation, and restore shoulder function. Common approaches include:

• Rest and activity modification: Avoiding activities that exacerbate symptoms and modifying movement patterns to reduce shoulder stress.
• Ice therapy: Applying ice packs to the affected area for 15-20 minutes several times a day to reduce swelling and pain.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter medications like ibuprofen or naproxen may help alleviate pain and inflammation.
• Physical therapy: Performing specific exercises to strengthen the rotator cuff muscles, improve shoulder mechanics, and address muscle imbalances.
• Corticosteroid injections: Injections of corticosteroids into the subacromial space can provide temporary relief of pain and inflammation.
• Surgical intervention: In cases of severe or persistent symptoms that do not respond to conservative treatments, surgical procedures such as arthroscopic subacromial decompression may be considered to create more space in the shoulder joint and alleviate impingement.

Prevention:

Preventing shoulder impingement syndrome involves:

• Maintaining good posture: Avoiding rounded shoulders and forward head posture to reduce strain on the shoulder structures.
• Strengthening and stretching exercises: Incorporating regular exercises to improve shoulder strength, flexibility, and stability, particularly for the rotator cuff and scapular muscles.
• Using proper lifting techniques: Lifting objects with the arms close to the body and avoiding excessive overhead reaching can help prevent shoulder strain and impingement.

Outlook:

With appropriate treatment and rehabilitation, most individuals with shoulder impingement syndrome experience significant improvement in symptoms and return to their normal activities. However, adherence to preventive measures and ongoing shoulder conditioning is essential to minimise the risk of recurrence. If symptoms persist or worsen, it is important to seek further evaluation and treatment from a healthcare professional.