Brief Outline of Shoulder Impingement Syndrome

Shoulder impingement syndrome is a chronic condition caused by repetitive overhead activity or throwing events that damage the glenoid labrum, long head of the biceps brachii, and the subacromial bursa. A narrowing of the space between the rotator cuff and the acromion results in shoulder pain and loss of movement, due to deficit in the affected rotator cuff, a group of muscles and tendons necessary to secure the arm to the shoulder joint. The rotator cuff permits free rotation of the arm.

Shoulder Impingement

Anatomy and physiology

The rotator cuff is composed of four muscles: subscapularis, supraspinatus, infraspinatus and teres minor, as well as their musculo-tendinous attachments. The subacromial bursa (a fluid-filled sac), is the largest and most commonly injured bursa in the shoulder region, and provides the rotator cuff with lubrication to assist movement. The rotator cuff acts to stabilise the glenohumeral joint. Damage, including tears to the rotator cuff, can cause the humeral head to migrate during elevation of the arm, leading to impingement.

Cause of Shoulder Impingement Syndrome

Repeated overhead movements as in tennis, swimming, golf, and weight lifting. Irritation of the rotator cuff due to throwing sports including baseball. Underlying predisposition, including rheumatoid arthritis.

Signs and symptoms

Shoulder pain and difficulty raising the arm in the air. Pain during sleep when the injured arm is rolled on. Pain during rotational movements such as reaching into a back pocket.

Complications if left unattended

Increasing stiffness of the joint and further loss of motion may result should impingement be ignored. Rotator tendons may be torn, should athletic activity be undertaken prior to full recovery. Tendinitis and bursitis frequent develop with impingement as a pre-condition.

Treatment

Rehabilitation and prevention

Following a period of healing, physical therapy will often be used to restore strength and range of motion in the affected rotator cuff. Avoiding or limiting repetitive motions that cause rotator cuff irritation may help prevent the injury. Strengthening exercises and lightweight training to strengthen the muscles of the rotator cuff are also useful preventive measures.

Long-term prognosis

Typically, the condition shows marked improvement within 6-12 weeks. In cases where recovery has not been achieved in 6-12 months, surgery may be recommended to release the ligaments. Surgery is usually followed by physical therapy, and some modification of athletic activity may be necessary to reduce the chances of relapse.

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