Man holding shoulder in pain

My Doctor Says I Have Shoulder Impingement, What Does That Mean?

If you have been diagnosed with shoulder impingement you are probably experiencing a range of debilitating symptoms including pain moving from your shoulder down as far as your wrist when you lift your arm or reach in front of you, difficulties sleeping due to pain or achiness in the affected areas, problems reaching behind your back and general stiffness or weakness in your arm and/or shoulder.

What is shoulder impingement?

Shoulder impingement occurs when your rotator cuff – a group of muscles and tendons that surround the shoulder joint – gets pinched or rubbed between the humerus and the acromion part of the scapula (shoulder blade). You use your rotator cuff to lift your arm away from your side and to rotate it towards and away from your body. It also has an important action when you hold your arm in front of you for prolonged periods e.g when working. Most sufferers have variations in the shape of their shoulder blade bone which makes them prone to the issue.


How does shoulder impingement occur?

If you develop damage in your rotator cuff, the attempted repair by your body causes an inflammation, especially in the neighbouring sac of lubricating fluid called the subacromial bursa. When there has been constant rubbing, bony spurs can develop on the acromion bone exacerbating the problem by reducing the space for movement even further. It may become a vicious cycle.

Patients who develop shoulder impingement tend to a have predisposition in their bone structure. Either the shoulder socket faces too far upwards, or the acromion bone is too wide, or both. Occasionally an impinging bone spur forms from a process called enthesitis, which is a condition affecting the attachment of tendons and ligaments to bone. Such people usually also suffer from conditions such a Achilles tendinitis (runner’s heel) and tennis elbow.


Who is susceptible to shoulder impingement?

Shoulder impingement most often occurs at a younger age in people who are predisposed but also make a lot of overhead and rotational movements with their arms, such as sportsmen and women (including swimmers, tennis and volleyball players) and certain types of manual workers, such as painters and decorators and hairdressers. These people are particularly prone to overuse injuries. The condition can also develop following a fall onto an outstretched arm or directly onto the shoulder which results in injury.


How common is shoulder impingement?

Shoulder impingement (also called shoulder impingement syndrome) is extremely common in a person’s lifetime and is believed to account for up to two thirds of all shoulder pain. There is now conclusive evidence that, if left untreated, impingement syndrome tends to progress to a full tear of the rotator cuff, although the speed of progression is variable.


Diagnosing shoulder impingement

It is important to get a proper diagnosis if you have shoulder pain as it may be caused by a range of other conditions such as a torn rotator cuff or biceps muscle. Your doctor will examine the affected shoulder for pain and tenderness and may ask you to make certain movements to assess the range of motion in your shoulder and any pain response. You may need an X-ray to rule out arthritis or to identify bony spurs. MRI or ultrasound is often used to clarify the diagnosis.


Treatments for shoulder impingement

For mild symptoms, resting the affected shoulder and using ice packs once or twice a day to reduce inflammation are recommended, alongside painkillers and anti-inflammatory medication. When the pain is more under control, physiotherapy can help to increase the range of motion in your shoulder and build strength in your rotator cuff, and other muscles that will help balance your shoulder against the predisposing bone structure.

If the symptoms are more severe, you may be offered an injection of corticosteroids and local anaesthetic into the affected shoulder. Ultrasound is often used to guide the location of the injection for maximum effectiveness. It can take a few days for the steroid injection to take effect and the benefits – which include a reduction in pain and swelling – normally last for several months, which is a good window of opportunity to engage with physiotherapy.

In the most serious cases of shoulder impingement, you may require surgery, but this is now quite rare. Arthroscopic shoulder decompression uses keyhole surgery to remove part of the acromion in order to create more space for the rotator cuff.

For more information about diagnosing and treating shoulder impingement, contact us.


Orthopaedic Consultant & Surgeon | London

Thames Shoulder & Elbow are able to provide advice and support to anyone experiencing symptoms affecting the upper limbs (shoulder, upper arm, elbow, forearm and wrist).

Telephone: 020 376 15987

Email: admin@thamesshoulderandelbow.co.uk

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