Injuries and Conditions: Shoulder: Shoulder Impingement: Medical Details
Overview The shoulder is a complex and unique joint. The muscles which support and stabilize the shoulder literally hold the joint together, as opposed to the mechanics involved in the hinged joints of the elbow or knee. Shoulder impingement syndrome is categorized into four stages based on the severity of the injury.
Stage I: Swelling and Mild Pain
Stage II: Inflammation and Scarring
Stage III: Partial or Complete tears of the rotator cuff
Stage IV: Rotator Cuff Arthropathy
Causes of Injury
Impingement occurs when inflammation or bony spurs form in the shoulder joint.
Rotator cuff injury can occur from the repetitive movement of the rotator cuff against the rough surface of an inflamed degenerative joint.
Degenerative rotator cuff tear associated with impingement occurs most commonly in patients in their mid-40's to late 60's.
Sports involving repetitive overhead movement.
Sports commonly associated with symptoms of impingment include tennis, swimming, baseball, softball and volleyball.
Heavy overhead lifting that places repetitive stress on the shoulder can lead to impingement and cause a tear in the rotator cuff.
Poor posture may cause a shoulder, muscles, or tendons to become pinched under the top of the shoulder (acromion) and lead to impingement.
A detailed history and physical exam should be conducted by an orthopedic surgeon to confirm the symptoms of impingemet. Rotator cuff tears, impingement syndrome, frozen shoulder, shoulder arthritis or a nerve injury within the shoulder may present similar symptoms on initial examination. The physical exam may include movement and resistance tests that will help to determine stability, flexibility and strength in the shoulder and assist in the making of the diagnosis of impingement.
The clinical findings may indicate a shoulder impingement, but to make an accurate and complete diagnosis, radiographic imaging studies may also be ordered. These tests will provide the physician with highly detailed views of your shoulder's muscles and tendons. Plain X-rays will be taken of the involved shoulder to evaluate the bones. An MRI (magnetic resonance imaging scan) may also be ordered. The images from the MRI will show if there is inflammation, tears, or other conditions or problems with the muscles and tendons.
After review of the clinical findings by your orthopedic surgeon, and shoulder impingement is confirmed, your physician will discuss surgical versus non-surgical treatment options. In patients over the age of 60 or with those who have increased health risks, surgical treatment is suggested only after a careful assessment of all risk factors.
Pain or weakness is present with overhead arm activities.
Muscles may "catch" or "grate" when your arm is rotated or raised.
Pain when sleeping on the affected side.
NSAIDs NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are a group of drugs used to control pain. This category of medications includes both prescription and common over-the-counter painkillers such as ibuprofen. NSAIDs are effective for many types of pain that can occur because of inflammation of muscles, joints and bones. The drugs work quickly and people often notice some benefit within a few hours of taking the tablet. However, the complete effectiveness of the drug may not be realized for up to four weeks. For each individual, some varieties of NSAIDs are more effective than others. Often, patients will find that one or two varieties are helpful whereas others may not be as effective in controlling symptoms. It is usually necessary to try several brands and continue with the one that is most suitable. NSAIDs can be used to treat: