Shoulder Impingement

Shoulder Pain When Raising Your Arm

What is impingement syndrome?

Shoulder impingement, or impingement syndrome, occurs when the space between the acromion and rotator cuff narrows as you raise your arm to shoulder height.  This causes the acromion to rub on the tendons and bursa.  This is the most common cause of shoulder pain in the adult population.  

How does impingement syndrome occur?

As patients age, the acromion edge fibroses and calcifies.  As this progresses over time, a spur eventually forms, narrowing the subacromial space and impinging on the rotator cuff.  Impingement of the shoulder can occur with repetitive lifting or overhead activities with use of the arm. Think cleaning, painting, throwing, swimming, or playing tennis.  Over time, bone spurs can develop from your acromion and undersurface of the clavicle in your shoulder, increasing your risk of having pain from impingement syndrome.

What are the symptoms of impingement syndrome?

Common symptoms with impingement syndrome include irritation and pain with possible loss of strength and motion with overhead activities. You can have pain radiating down the front of your arm and pain with lifting and reaching movements.  The most common presentation, which is diagnostic, includes the inability to sleep, take off a shirt cross armed, wash one’s own hair, and inability to reach a seatbelt.  If these are present, impingement syndrome is very likely.

How is impingement syndrome diagnosed?

Routine X-rays of the shoulder will be taken, and a detailed history and physical exam will be performed. Point of tenderness and range of motion (ROM) will be obtained. Pain when lifting and rotating your arm is indicative of impingement syndrome when coupled with above classic symptoms.  Immediate relief from an injection given in the doctor’s office can also help differentiate impingement syndrome from other sources of shoulder pain.  Also, an MRI will be considered to identify any other diagnosis, such as a possible rotator cuff tear, labral tear, and biceps tendon tear, and to aid in surgical planning.

How is impingement syndrome treated?

Initially this is treated conservatively with rest, ice, non-steroidal anti-inflammatory medications (NSAIDs), physical therapy, and steroid injections.

If conservative treatment fails, or if symptoms are severe, then surgery is the next step in eliminating your pain. Arthroscopic subacromial decompression is an outpatient procedure that removes some subacromial bone and tissue to give more space for the rotator cuff muscles and tendons. By opening this space up, you eliminate the cause of your pain.  During the surgery, all of the vital structures within the shoulder are examined and any other repairs at that time are performed.  The longer you delay treatment, the more chance there is the abrading of the acromion on the tendons of the rotator cuff which will result in a tear.  This operation is done as an outpatient procedure, and patients rarely have to spend the night. The procedure itself takes about 30 minutes with an average time in the facility 5 hours total, recovery is easy.

What is the recovery time for impingement syndrome treatment?

Recovery varies based on the extent of the condition and what is repaired in surgery. Our patients wear a sling for 24 hours after surgery. After that, they remove the sling and start an exercise program which can be done at home three times a day. You will do Phase I exercises three times a day until we see you at your 2-week follow-up appointment, at which time we will advance you to Phase II.  Physical therapy may be recommended at that time, however, most of our patients are able to have a full recovery using the home exercise program developed by Dr. Bramlett. Most patients resume light-duty work within a few days and progress to full-duty in 3 weeks to 3 months. The longer you delay surgery, the longer your recovery time will be.

We are here to help. If you believe you are suffering from one of these conditions, we would love to deliver a diagnosis, get you treated and get you moving again.

Case of the Week - Unicondylar Knee ReplacementDr. Bramlett explains the details of a Partial Knee Replacement

This procedure involves replacing a single compartment of the knee with a custom cobalt chrome implant. This allows for an easier recovery and simpler surgery by comparison to a full knee replacement.