Shoulder impingement syndrome is a very common cause of pain and over time can lead to inflammation of the rotator cuff tendons (tendinitis) and bursa (bursitis). It occurs when there is impingement of tendons or bursa in the shoulder from bones of the shoulder. Excessive activity of the shoulder, especially repeated activity, is a risk factor for shoulder impingement syndrome. Activities like lifting, painting, swimming, tennis and other overhead sports. Other risk factors include bone and joint abnormalities. With impingement syndrome pain is present and affects everyday activities such as putting on a coat or blouse, for example. If not treated appropriately, the rotator cuff can start to thin and tear. If tendons are injured for a long period of time, the tendon can actually tear in two, resulting in a rotator cuff tear. This causes significant weakness and some people can have rupture of their biceps muscle as part of this continuing impingement process.
The typical symptoms of impingement syndrome include difficulty reaching up behind the back, pain with overhead use of the injured arm and weakness of shoulder muscles. To diagnose impingement syndrome you have to start with a medical history and physical exam by your doctor. It will be necessary to take the X-ray to rule out arthritis, and may show changes in the bone that indicate injury of the muscle. Bone spurs or changes in the normal contour of the bone may be present.
The most common shoulder impingement treatment is with oral anti-inflammatory medications, such as aspirin, naproxen or ibuprofen. The medicine are usually given for 6 to 8 weeks since it often takes that long to fully treat the problem. This treatment should be done under the care of a doctor because these medications can cause stomach irritation and bleeding. There is no preferred medication for this condition as response to any given medication differs from person to person. If one inflammatory medication does not help within 10 to 14 days, then another will be given until one that provides relief is found. In addition to taking medications, daily stretching in a warm shower will help. You should work to reach your thumb up and behind your back. Avoid repetitive activities with injured arm, particularly activities where the elbow would move above shoulder level. Your doctor may refer you to a physical therapist who can demonstrate the exercises most affective in strengthening and stretching the shoulder muscles. If you have persistent symptoms, despite the use of oral anti-inflammatory drugs, your doctor may consider a cortisone-type injection. Cortisone is a potent anti-inflammatory medication, which should be used only when necessary because it can result in weakening of muscles and tendons if used repeatedly.
If symptoms persist or if significant weakness is present, then your doctor may perform an ultrasound, MRI, or arthrogram to rule out a rotator cuff tear. If the cuff is torn, surgery may be necessary to repair it.
The majority of people who have impingement syndrome are successfully treated with medication, stretching exercises, and temporary avoidance of repetitive overhead activity until the condition settles down.
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