Shoulder Impingement Syndrome - What is Impingement?

Shoulder Pain?

 Shoulder impingement syndrome is a common condition and is responsible for a significant proportion of shoulder related doctor visits.
 Impingement can be a primary condition but is also a common secondary complication of other injuries.

Impingement causes pain by the compression of soft tissue structures in the shoulder. Because we continually use both our arms we find it difficult to rest following injury or the initial onset of the pain.
This makes it a difficult condition to treat and many cases become chronic.
Early diagnosis and intervention make Shoulder Impingement Syndrome much easier to treat and non-invasive interventions more successful.

Shoulder Anatomy

An Xray of the left shoulder, seen from straight in front. The Sub-acromial space is seen between the top of the humerus and the Acromion above
An Xray of the left shoulder, seen from straight in front. The Sub-acromial space is seen between the top of the humerus and the Acromion above

What Causes Shoulder Impingement?

 Impingement is caused by the compression of soft tissues under a bony arch known as the Acromion. The Acromion is located at the point of the shoulder and is a projection coming off the scapula or shoulder blade.
The soft tissues in question pass between the acromion and the head of the humerus - better known to most as the ball part of the shoulder's ball and socket joint.

The gap between these two bones is called the sub-acromial space. The shoulder's rotator cuff muscles and a bursa (a kind of fluid filled sac that helps tendons glide smoothly) occupy this space.
Impingement occurs when these structures become aggravated, often through trauma but sometimes with no identifiable cause. Once annoyed they become inflamed, swelling in an already tight space.
This makes them more likely to be compressed again with any arm movement and a vicious cycle is formed. As you continue to use your arm you continually feed into the inflammation cycle and the condition perpetuates.

Symptoms of Impingement

 Impingment usually causes pain to a large area of the shoulder rather than a specific point. People typically complain of a generalized tooth ache like pain over the side and front of their shoulder. As the pain gets worse it can travel further down the arm towards the elbow.

With the pain of impingement, it is often difficult to find a position of comfort. Even supporting the arm across the body like it's in a sling often doesn't help.

One of the classic signs of shoulder impingement is called the "Painful Arc". This is assessed by raising the arm up straight out the side. The test is positive when the movement starts as pain free when moving off the thigh, becomes painful through the middle section before again being pain free when the arm is in the upper range and straight up. In severe cases the pain is too great to get past the painful section of the arc.

Because Shoulder Impingement Syndrome can often start as a very minor complaint, it is normal for people to put up with it for a considerable amount of time before consulting their doctor. By this time, it is limiting most activities involving that arm and become more difficult to treat.

Due to normal anatomical difference in our body shape, some people are more susceptible to impingement than others. This can lead to impingement being present in both arms at some stage of their life.

Shoulder Impingement Treatment

The first line of treatment for shoulder impingement should always be physical therapy. It is non-invasive and has a very low risk of complications. A large number of cases can be resolved with the use of physical therapy alone, particularly when treatment starts promptly.

For cases that don't respond to physical therapy, the next step is usually an injection into the sub-acromial space. A doctor injects a corticosteroid (often combined with a local anesthetic) into the offending area. This acts as a strong local anti-inflammatory, reducing the swelling in the space that is leading to continuing aggravation. For lucky people, this will resolve the problem completely. For most, it will reduce their pain and provide a window of opportunity for them to make progress with their physical therapy.

When both injections and physical therapy fail to resolve the problem, the final step is key-hole surgery. A surgeon places an arthroscope into the joint to assess the problem and shaves the bottom of the acromion off. This creates more space and prevents the soft tissues from continually being aggravated. This type of surgery is usually done on a Day Case basis and is known as an Acromioplasty, or Sub-Acromial Decompression. The recovery time is relatively quick - if a shoulder sling is used at all it is only for 24 - 48 hours for comfort and early active movement is encouraged. Many people return to work in the same week as their surgery.

Comments 15 comments

Acquilles profile image

Acquilles 7 years ago from Lucknow

Well I didn't know all this, gr8 info!!


thestickman 6 years ago

I have this. Injury-related. Had it for years. I finally talked to my doctor about it and after several visits, several x-rays, he finally ceded to me that it was time to try steroid injection and OMG it STOPPED HURTING immediately! This helped me get the arm mobile again, but it's been a few months and the pain is returning. I am all but begged for a second steroid injection but doctor refuses; corticosteroid is damaging to tendons apparently (If I understood the explanation) and for my greater benefit, he refuses to inject me again so soon.

Damn I'd risk it I mean I am in PAIN day and night (esp. at night) HELL sometimes I wake and my arm is SO SORE that I cannot roll over! I have to take my sore arm like it is broken, in 'sling fashion' to my chest and very painfully, roll over. I am suffering! Your article describe EXACTLY 100% what I have been going through now for about 10 years... I may be reaching the point of demanding surgery I mean seriously, -there are times late at night I really think the arm would ache LESS if it were amputated! I am sick & tired of waking from pain-ridden dreams to painful reality, sometime almost in tears, with this $%&*@ achy shoulder...

This is a GREAT article, -I intended to submit to Stumble.

-thestickman


mcbean profile image

mcbean 6 years ago from A planet far, far away Author

Hi Stickman,

Unforunately your story is very common to me as many people are in the same boat. Your doctor is correct in being reluctant to do repetitive steroid injections as there is some concern they may lead to tendon rupture. This would create a bigger problem.

If the injection helped but only temporarily you have an underlying mechanical problem that needs to be addressed. You may be looking at a subacromial decompression which is simple, relatively minor surgery and generally very effective.

Good luck.

McBean


MrsMontgomery 6 years ago

Thank you for this article it has really put my mind at rest. As a healthy woman in my 20's I was completely unprepared to have such chronic debilitating pain so young. It's taken me 2 years to finally get a diagnosis, during my appointment with the consultant I mentioned just that week my other shoulder had begun to hurt too, I was told that it's due to extra strain because of the injured shoulder. A couple of weeks later the 'good' shoulder is getting worse, I was beginning to worry that I might have some sort of debilitating disorder and was almost preparing to buy a one way ticket to Dignatas. I will be printing this page put and showing to my DR.

Thank you for giving me some hope.


marie turnbull 6 years ago

got shoulder impingement through work was off for three months, got injection had ten months of physio. Had a bit of release from it thought I was nearly on the mend as I was resuming all normal activities when a year down the line it acts up again only in other shoulder not as bad as the other but still gave me a shock, work changed my job. Thought it was a good move away from repetive activity but now there is lifting frequently, shoulder is playing up really bad, back at physio but it seems to be getting worse especially after physio. At end of tether wonder if surgery would help


M Turnbull 6 years ago

I am now unable to go into work, the pain in my (L) shoulder which has the impingement has flared up it is no were near bad as it once was but know to take a big step back to prevent this. I am on anti-inflammatories and I am doing mild band exercises three times a day to try and strengthen the muscles. I am not in enough pain for painkillers as it is not the screaming pain it once was and is just an ache. The doc seems to think I have pulled a muscle at the back of it in the shoulder blade with overstretching and reaching overhead for things. I'm really hoping this is the case, although I know myself I'm getting a bit of impingement pain, won't really know until I see physio next week. Of all the luck this had to be the week she's on holiday. I've also requested a hospital appointment for x-rays so I'm waiting for that. Have purchased a shoulder support but again will have to get physio approval on that and I'm going to ask if there are any benefits from acupuncture. Has anyone looked into or tried acupuncture?


mcbean profile image

mcbean 6 years ago from A planet far, far away Author

Hi Marie,

Acupuncture has mixed results. For the shoulder most studies show either a mildly positive outcome or are inconclusive. Some people benefit and some don't. I feel it is worth a try, if it helps - great, if not at least you know now.

Surgery is a last resort but relatively simple and effective. A subacromial decompression is keyhole day surgery and has a short recovery time compared to most other types of surgery. As you have had it in both shoulders it is likely you have the shape of acromium (part of the shoulder blade that forms an arch above the head of the humerus) most at risk of developing impingement.

If it is really starting to affect work and lifestyle, it wouldn't hurt to speak to a shoulder surgeon.


sydney 5 years ago

i have recently been diagnosed with impingement syndrome. i have had it for about 10 months now but have been out of sports and all overhead activities for a few months now and i have been in physical therapy. how long will my injury occur for?


mcbean profile image

mcbean 5 years ago from A planet far, far away Author

As Impingement Syndrome is not an injury as such but more an ongoing condition, it tends to persist until the underlying cause is addressed. The hardest part of a physical therapy program is the start as everyone wants instant results but it rarely occurs this way. Being persistent is the key as once the critical point is reached and symptoms start to decrease, quick improvements are possible.

Not quitting until you get to this point is the primary objective.


urban33 5 years ago

Ok I have played softball 7 years. going on 8.i am now a junior. my 8th grade year i started to get a real sharp pain in my shoulder. it got worss and worss i couldn't even sleep at night. i went to the doctors, got M.R.S and they all told me different things. i experience awful pain through out my shoulder and down my arm. iv been to therapy 4 times and i cant find anything to fix the pain. im thinking about putting it in a sling and keeping it still. littlest movement hurts like crazy. and I'm tired of going to different doctors. softball season starts in 1 month and i have no idea if its okay to play. i need advice bad and quick!!


eve 4 years ago

I hav had shoulder pain for five months that is just getting worse. It is now so debilatating that I had to hav hair cut short as couldn't comb it. I have had physio and injection, the latter only giving temporary relief. My question is why is my gp so reluctant to refer me to orthopedic specialist? I had an xray which was normal but physio felt I should have MRI an say they can't do anymore for me. My docs response is to re-refer back to physio. Please advise as I cannot drive or even concentrate at work due to now constant pain. I can't take anti-inflammatory


ANNIE CAMPBELL 4 years ago

Had this for 3 yrs of hell,decided to have a decompression in that area,but that's has come back with avenges,I AM IN SO MUCH PAIN


dp 3 years ago

I've been seeing a physio for two months now but my shoulder is getting worse. Is it time to go back to gp or should I give the physio a bit longer


Jasemin 23 months ago

Great hammer of Thor, that is polwlfurey helpful!


Nico 23 months ago

Hell no. I'll tell you how to get it fixed fast. Go into the emergency room hcenhud over and act like your dying of pain. They will give you all kinds of pain killers and you say it STILL hurts real bad. You will end up in surgery. After they remove SOB disc you will still have a little pain, but not as bad you do now. Took me ten years of misery to find that out. My nerves are still shot, but I am now pain free. Hope that helps.

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