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Shoulder Impingement

Shoulder impingement is the most common cause of shoulder pain in young and middle aged people. It occurs due to mechanical compression of the rotator cuff muscle between the acromion process of the shoulder blade and the humeral head of the arm.

Anatomy
Three bones namely the bone of the upper arm (humerus), the shoulder blade (scapula), and the collarbone (clavicle) together make the shoulder joint. Rotator cuff is the group of four tendons that join the head of the humerus to the deeper muscles. Acromion is a protuberance of the shoulder bone, and scapula. Ligaments are thick strands of fibers that connect one bone to another. Ligaments connect the collarbone to the shoulder blade at the acromion process. Bursa is a sac between the acromion process and the rotator cuff. It contains a lubricating fluid, which prevents friction between the moving rotator cuff and the acromion.

Causes
Shoulder impingement may occur due to:

  • The bone growth of the acromion process
  • Inflammation of the fluid present below the rotator cuff muscles and the glomerular humeral joint (bursitis). This fluid prevents rubbing of the rotator tendons to the underlying bone of the shoulder joint
  • Degeneration of the tendons with age, particularly in people above 40 years
  • Overuse injury of the tendons, which occurs more often in sports persons and in those people whose occupation requires a lot of shoulder movement such as raising the arm above the shoulder: usually tennis players, swimmers, construction workers and painters. It is also seen in people who require keeping the arm in the same position for long time such as computer professionals, or those who sleep on the same arm for few nights.
  • It may occur also due to injury: one hard throw may cause the problem

Diagnosis
Diagnosis includes physical examination by the doctor; wherein the doctor would check for the range of movements possible with the affected shoulder. He may ask for an X-ray to rule out other causes of the pain such as arthritis or to check if shoulder impingement is due to a bone spur. Soft tissue like muscle and tendons cannot be seen by an X-ray. To rule out the other causes and in case suspecting shoulder impingement due to inflammation of bursa, your doctor may ask for a MRI. Generally, MRI is rarely used for diagnosis of shoulder impingement. If injection of an anesthetic drug in the space below the acromion gives relief in pain, it confirms that the pain was due to shoulder impingement.

Treatment
Treatment generally involves avoiding overhead activities completely for some time to rest the affected tendons and muscles. Oral non-steroidal anti-inflammatory drugs (NSAIDs) are given to reduce inflammation and thus help in decreasing pain and swelling. Some shoulder muscle strengthening exercises are also advised. Showering with warm water may help in providing some relief from the pain. If this does not provide relief, injection of corticosteroid (a strong anti-inflammatory agent) and local anesthetic may be given (only when necessary) at the bursa, below the acromion and not in the rotator cuff muscles. Side effects of corticosteroid injection may include tendon weakening and tendon rupture. It usually takes few months to recover completely. If this does not help, your doctor may advise surgery.

Surgery aims at creating more space for the rotator cuff by removing the front (anterior) edge of the acromion bone and by removing the inflamed tissue of the bursa. It can be done as an open surgery or arthroscopy. In open surgery, an incision is made in the front of the shoulder to reach the rotator cuff and the acromion. However, in arthroscopy, a minimally invasive surgical procedure, a pen-sized instrument called an arthroscope and other surgical tools are inserted individually into the shoulder joint through two or three small incisions. The arthroscope has a camera, which projects a large picture of the joint on the television monitor for the surgeon. Additionally, the flow of fluid in the joint through the arthroscope keeps the joint inflated to allow space for the surgical tools and provide a clear view. The incisions of arthroscopy are sutured or closed by a tape. The advantage of arthroscopy is that it is less painful and does not have any complications associated with open surgery, as the incisions are small. Majority of the patients are happy with the results of the surgery.

After surgery, pain medication is given to relieve the pain and arm will be placed in a sling. Depending on the healing and your comfort the sling will be removed and you will be asked to do physical exercises of the shoulder to get back the functional mobility and strength to the shoulder muscle. Complete recovery may take a year or so.

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Houston Shoulder Specialists

Advanced Orthopedics and sports medicine has numerous Board Certified/Eligible physicians who are thoroughly educated in the latest treatment techniques both surgical and conservative. They are well versed in advances in shoulder treatments including arthroscopic rotator cuff and Bankart repairs, shoulder stabilization procedures, total shoulder replacement and reverse shoulder replacement.

Drs Elbaz and Brooks now perform Platelet-Rich Plasma (PRP) injections for the treatment of rotator cuff tendinitis, and biciptal tendonitis. PRP stimulates a more rapid healing of tendon, ligament, muscle and bone.

Contact us today to Schedule an Appointment or call us at 281-955-2650 to learn more about our Shoulder Treatment options.

Our Locations
  • 1Professional Building II At North Cypress Medical Center
  • 2North Cypress Professional Building At Lakewood Crossing
  • 3North Cypress Professional Building At Towne Lake
  • 4Houston Professional Building

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