Overview of Impingement Syndrome

Many people are probably familiar with the term bursitis. Any pain in the shoulder is sometimes mistakenly referred to as bursitis. The term bursitis only means that the part of the shoulder called the bursa is inflamed. There are many different problems that can lead to symptoms from inflammation of the bursa, or bursitis. Impingement is one of those things that can cause bursitis.

Causes of Shoulder Impingement

Usually, there is enough room between the acromion and the rotator cuff for tendons to slide easily underneath the acromion as the arm is raised. But each time the arm is raised, there is a bit of rubbing on the tendons and the bursa between the tendons and the acromion. This rubbing, or pinching action, is called impingement. Impingement occurs to some degree in everyone’s shoulder, caused by day-to-day activities.

Continuously working with the arms raised overhead, repeated throwing activities, or other repetitive actions of the arm can cause impingement to become a problem. Raising the arm tends to force the humerus against the edge of the acromion. With overuse, this can cause irritation and swelling of the bursa.

Symptoms of Shoulder Impingement Syndrome

Early symptoms of Impingement Syndrome include:

• Aching pain in the shoulder
• Pain when raising the arm out from the side or in front of the body
• Difficulty sleeping due to pain
• Sharp pain when trying to reach into your back pocket

As the process continues, discomfort increases and the joint may become stiffer. Sometimes a “catching” sensation is felt when the arm is lowered. Weakness and inability to raise the arm may indicate that the rotator cuff tendons are actually torn.

Nonsurgical Treatments for Shoulder Impingement

There are many nonsurgical treatments for shoulder impingement, including:

• Medication: Anti-inflammatory medications such as aspirin and ibuprofen
• Cortisone injections: Cortisone is a very strong anti-inflammatory medication and can reduce the inflammation in the bursa and tendons of the rotator cuff
• Rest: Your physician or therapist may prescribe a sling to provide adequate rest to the shoulder
• Ice: Ice decreases the size of blood vessels in the sore area, halting inflammation and relieving pain.
• Physical Therapy: These programs are a set of exercises that will help keep the shoulder strong and flexible and help reduce the irritation from impingement

Be sure to talk to your pharmacist before purchasing anti-inflammatories as these medications may be contraindicated as they may interact with other medications and medical conditions.

Shoulder Surgery

Surgery to the shoulder to relieve the constant rubbing of impingement is not uncommon. The goal of surgery is to increase the space between the acromion and the rotator cuff tendons. The first thing that must be done is to remove any bone spurs under the acromion that are rubbing on the rotator cuff tendons and the bursa. Usually, a small part of the acromion may be removed to give the tendons even more space and allow them to move without rubbing on the underside of the acromion. In patients who have an abnormal tilt to the acromion, more of the bone may need to be removed.

In some cases, this can be accomplished using the arthroscope. The arthroscope is a small TV camera that can be inserted into the joint through a small incision. Through other small incisions around the joint, the surgeon can insert special instruments to cut away bone while observing the operation on a nearby monitor. If your surgery is done with the arthroscope you may be able to go home the same day.

In other cases, an open incision is made to allow removal of the bone. Usually, an incision about three or four inches is made over the top of the shoulder. Any bone spurs are removed and a part of the acromion is removed and smoothed by the surgeon. If necessary, the end of the clavicle is removed to perform the resection arthroplasty of the acromioclavicular (AC) joint. If your surgery is done in this way, you may have to stay a night or two in the hospital.