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Shoulder impingement syndrome: Treatment, symptoms, advice & help

About shoulder impingement syndrome

Shoulder impingement syndrome is a condition caused by the inflammation (tendonitis) or a partial or full-thickness tear of the rotator cuff, within the subacromial bursa.

Shoulder impingement syndrome: Incidence, age and sex

No documented information on the occurrence of shoulder impingement syndrome exists. Although rotator cuff tears are more common in the older population, impingement and rotator cuff disease are frequently seen in the repetitive overhead athletes and labourers.

Signs & symptoms of shoulder impingement syndrome: Diagnosis

The syndrome is characterized by pain and weakness on abduction and internal rotation. The pain is often worsened by shoulder overhead movement and may occur at night, especially if the patient is lying on the affected shoulder. Painful arc test i.e. the patients are asked to abduct their arms from their sides-the presence of pain from 60 to 120 is positive. Plain x-rays of the shoulder can help detect joint pathology and variations in the bones. Ultrasonography, arthrography and MRI can be used to detect rotator cuff muscle pathology.

Causes & prevention of impingement syndrome

This can be caused by bony projections from the acromion, variations in the shape of the acromion, thickening or calcification of the ligament around the joint, loss of function of the rotator cuff muscles due to injury or loss of strength and inflammation and subsequent thickening of the subacromial bursa. Primary prevention includes education of patients at risk -athletes, particularly those involved in throwing and overhead sports, and labourers with repetitive shoulder stress should be instructed in proper warm-up techniques, specific strengthening techniques and have a good understanding of the warning signs of early impingement.

Shoulder impingement syndrome: Complications

If not diagnosed and treated promptly and correctly, it can progress to rotator cuff degeneration and eventual tear. Other complications are progression to adhesive capsulitis, cuff tear arthropathy, and reflex sympathetic dystrophy. Complications also may result from surgery, injection, physical therapy, or medication.

Shoulder impingement syndrome: Treatment

Conservative treatment includes rest, NSAID's and ice packs for pain relief. Cessation of painful activity and physiotherapy is necessary to maintain range of movement and avoid shoulder stiffness. Therapeutic injections of corticosteroid and local anaesthetic may be used for persistent pain. Surgery may be done arthroscopically or as open surgery to remove the impinging structures and the subacromial space may be widened by resection of the distal clavicle and excision of osteophytes on the under-surface of the acromioclavicular joint. Also damaged rotator cuff muscles can be surgically repaired.