Shoulder Impingement Syndrome

Dr. Renny Uppal, MD

What is Shoulder Impingement Syndrome?

Shoulder impingement syndrome refers to mechanical compression and/or wear of the rotator cuff tendons. The rotator cuff is actually a series of four muscles and tendons connecting the scapula (shoulder blade) to the humeral head (upper part of the arm bone). These muscles are located deep in the shoulder, beneath the deltoid muscle that gives your shoulder its contour. The rotator cuff is important in maintaining the humeral head within the socket during normal shoulder function and also contributes to shoulder strength during activity. Normally, the rotator cuff glides smoothly between the undersurface of the acromion (shoulder cap) and the humeral head.

How Does Shoulder Impingement Occur?

Any process, which compromises the normal gliding function of the rotator cuff, may lead to mechanical impingement. Common causes include weakening and degeneration within the tendon due to aging, the formation of bone spurs and/or inflammatory tissue within the space above the rotator cuff (sub acromial space), and overuse injuries. Activities that can lead to impingement most commonly involve repetitive overhead motion. This is typically seen in such things as painting, carpentry, tennis, baseball, swimming, etc.

How is Shoulder Impingement Syndrome Diagnosed?

The diagnosis of shoulder impingement syndrome can usually be made with a careful history and physical exam. Patients with impingement most commonly complain of pain, pinching, and stiffness in the shoulder, which is worse with overhead activity and sometimes severe enough to cause awakening at night. Manipulation of the shoulder in a specific way by your doctor will usually reproduce the symptoms and confirm the diagnosis. X-rays are also helpful in evaluating the presence of bone spurs and/or the narrowing of the sub acromial space. MRI (magnetic resonance imaging), a test that allows visualization of the rotator cuff, may be used to rule out more serious diagnoses such as rotator cuff tears.

How is Shoulder Impingement Syndrome Treated?

The first step in treating shoulder impingement syndrome is eliminating any identifiable cause or contributing factor. This may mean temporarily avoiding overhead activities like tennis, pitching or swimming. A non-steroidal anti-inflammatory medication, such as Advil or Motrin, is helpful in alleviating pain and swelling. The mainstay of treatment involves exercises to restore normal flexibility and strength to the shoulder girdle, including strengthening both the rotator cuff muscles and the muscles responsible for movement of the shoulder blade. This program of instruction and exercise demonstration may be initiated and carried out either by the doctor or a skilled physical therapist. An injection of cortisone into the sub acromial space is often helpful in treating this condition.

Is Surgery Necessary?

Surgery is not necessary in most cases of shoulder impingement syndrome. If symptoms persist despite adequate non-operative treatment, surgical intervention may be beneficial. Surgery involves debriding, or surgically removing tissue that is irritating the rotator cuff. This is done on an outpatient basis with arthroscopic techniques that are minimally invasive.

After surgery patients use a sling for comfort, but may begin using the arm for everyday activities as soon as pain allows. Complete recovery may take three months. Outcome is favorable in about 90% of cases.

The sports medicine orthopedic surgeons at the Reno Orthopedic Center have extensive experience in performing arthroscopic shoulder surgery. As our patient, you can be assured of the best possible treatment available today.