shoulder careShoulder Impingement Syndrome is the result of chronic “impingement” (compression) of the tendons surrounding the rotator cuff in the shoulder. The condition causes pain and problems with normal shoulder movement.

Shoulder Anatomy
Your shoulder is made up of numerous parts, including three bones (the humerus, the clavicle and the scapula). The rotator cuff is made up of muscles and tendons that form a covering around the “head” of the upper arm bone (humerus), and attach it to the shoulder blade (scapula). In essence, your rotator cuff is what keeps your arm in its socket!

Who Tends to be at Risk for Shoulder Impingement?
A part of the shoulder called the acromion, a bony structure located just above the tendons surrounding the rotator cuff, rubs against the tendons of the rotator cuff when you raise your arms over your head. Normally, this wouldn’t be a problem, but when you’re repeatedly and frequently raising your arms — the way swimmers and tennis players do, for example — the regular rubbing against those tendons can irritate them and cause pain and restricted movement.

People whose professions or hobbies call for repeated raising of the arms (athletes, paper-hangers, house painters, etc.), are especially susceptible to shoulder impingement, although the condition can also result from an injury to the shoulder, an abnormality in the acromion or even osteoarthritis.

Specifically, shoulder impingement may cause difficulty in moving your arm overhead, reaching behind you or moving your arm out to the side. All of these motions will likely cause pain. You may also find that it’s too painful to sleep on your side on the affected shoulder. You may experience weakness when attempting to move your arm to perform everyday activities such as reaching for an item on a shelf, pulling on a seat belt or tossing a ball to your dog.

Your doctor will do a physical examination to determine the cause of your shoulder pain, probing for tender areas, examining range of motion and asking questions regarding the location and severity of your pain. He or she may also order X-rays to rule out certain possibilities or to confirm an initial diagnosis. If nothing shows up in the X-rays, your orthopaedist may also order a MRI, which gives a clear image of soft tissues in the shoulder. Once your physician has confirmed that you’re suffering from shoulder impingement, you will discuss a recommended treatment protocol, which is most often nonsurgical.

Initial Treatment
Treating shoulder impingement nonsurgically typically involves three components:

  • Rest: eliminating activities that cause an increase in symptoms.
  • Anti-Inflammatory Medicines: ibuprofen or naproxen will help reduce pain and swelling.
  • Physical Therapy: a physical therapy program is key to restoring range of motion without causing further damage.

In the beginning of treatment, when pain is most acute, your physical therapist will prescribe gentle strengthening exercises that target the rotator cuff, aiming to prevent the muscles from atrophying and slowly increase range of motion without causing additional damage. The exercises involve stretching and strengthening those muscles, increasing in frequency and intensity as pain decreases, and movement begins to be restored. In addition to prescribing exercises, your physical therapist may also manipulate or massage the affected area, as well as teach you to avoid movements that are likely to cause pain while you’re healing.

More Invasive Treatment
If your shoulder impingement doesn’t improve using the nonsurgical options listed above, your orthopaedist may try an injection of cortisone into the bursa (a fluid-filled small sac between a tendon and a bone) underneath the acromion to further reduce inflammation and relieve pain.

If you’re still experiencing pain and restricted movement, surgery to create more space for the rotator cuff may be necessary. This may be arthroscopic –surgery performed through a series of small incisions with the aid of thin surgical instruments and a tiny camera — or traditional open surgery.

If you’re experiencing shoulder pain, don’t ignore it! In the Hampton Roads region of Virginia (including Newport News, Williamsburg and Yorktown), contact us at Hampton Roads Orthopaedics and Sports Medicine at (757) 873-1554 or request an appointment online for state-of-the-art care. We are known for our comprehensive orthopaedic care; innovative, minimally invasive surgical techniques; compassionate, patient-centered care; and our engaged, courteous team.