About Impingement Syndrome
Impingement syndrome is a common condition of the shoulder seen in aging adults. This condition is closely related to shoulder bursitis and rotator cuff tendinitis. These conditions may occur alone or in combination.
In virtually all parts of your body, bones are the innermost structures and are surrounded by muscles. When an injury to the rotator cuff muscle occurs, it responds by swelling. However, because the rotator cuff muscle is surrounded by bone, when it swells a series of other events occur. The pressure within the muscle increases, which results in compression and loss of blood flow in the small blood vessels (capillaries). When the blood flow decreases, the muscle tissue begins to fray like a rope. Motions such as reaching up behind the back and reaching up overhead to put on a coat or blouse, for example, increase pain.
What are the symptoms of impingement syndrome of the shoulder?
The typical symptoms of impingement syndrome include difficulty reaching up behind the back, pain with overhead use of the arm and weakness of shoulder muscles.
If these muscles are injured for a long period of time, the muscle can actually tear in two, resulting in a rotator cuff tear. This causes significant weakness and may cause inability to elevate the arm. Some people will have rupture of their biceps muscle as part of this continuing impingement process.
How is impingement syndrome diagnosed?
Diagnosis begins with a medical history and physical examination. X-rays are helpful 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. Impingement syndrome may be confirmed when an injection of a small amount of an anesthetic into the space under one of the shoulder bones relieves pain.
How is impingement syndrome of the shoulder treated?
It is important to understand that the condition and not just the symptoms should be treated. Oral anti-inflammatory medications, such as aspirin, naproxen or ibuprofen, remain the most common treatment for this condition. You must consistently take the medication for nearly eight weeks for it to be effective. Taking anti-inflammatories for a short period of time may treat the symptom of pain, but it will not treat the underlying problem and symptoms will come back. There is no specific medication for this condition and response to any given medication differs from person to person. If an oral medication does not help within 10 to 14 days, then other oral anti-inflammatory medications will be given until one that provides relief is found.
In addition to taking oral anti-inflammatory medications, daily stretching in a warm shower will help. Work to reach your thumb up and behind your back. Avoid repetitive activities with your injured arm, particularly where the elbow would move above shoulder level. Avoid vacuuming, painting, raking leaves and washing the car.
If you have persistent symptoms despite the use of oral anti-inflammatories, your physician may consider a cortisone type injection. Cortisone is a potent anti-inflammatory medication, which should be used only when absolutely necessary because it can result in weakening of muscle tendon tissue.
If symptoms persist or if significant weakness is present, then your physician may perform an MRI (magnetic resonance imaging) or arthrogram to rule out a rotator cuff tear. If the cuff is torn, surgery may be necessary.
The vast majority of patients 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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