Impingement Syndrome
Impingement syndrome is a condition of shoulder pain. The rotator cuff is a group of muscles and tendons that secures the arm to the shoulder joint and allows the arm to rotate. Overhead movement of the arm can cause the rotator cuff to contact the outer end of the shoulder blade where the collarbone is attached, called the acromion. Irritation of this tendon produces the so called impingement syndrome.
Impingement syndrome can occur spontaneously but is more likely to occur in people who engage in physical activities that require repeated overhead arm movements, (e.g. tennis, golf, swimming, repeated overhead lifting).
Impingement syndrome can be treated non-operatively with rest, ice packs, and anti-inflammatory medications. Physiotherapy can be very helpful, with treatment modalities such as ultrasound therapy to stimulate the tissues and improve blood flow, and stretching and strengthening exercises to re-establish shoulder movement and function.
In some cases, a limited number of corticosteroid injections into the space under the acromion to reduce inflammation might also be helpful. I pain persist, surgery may be necessary to increase the space above the rotator cuff tendon or even to repair the torn rotator cuff tendon.
Impingement syndrome is a condition that affects the rotator cuff, causing shoulder pain. The rotator cuff is a group of muscles and tendons that secures the arm to the shoulder joint and allows the arm to rotate. Impingement syndrome is more likely to occur in people who engage in physical activities that require repeated overhead arm movements, such as tennis, golf, swimming, weight lifting, or pitching a ball, or whose profession requires repeated overhead lifting. Impingement syndrome can also occur in people with rheumatoid arthritis.
Repeated movement of the arm overhead can cause the rotator cuff to contact the outer end of the shoulder blade where the collarbone is attached, called the acromion. When this happens, the rotator cuff becomes inflamed and swollen, a condition called tendonitis. The swollen rotator cuff can get trapped and pinched under the acromion. All these conditions can inflame the bursa in the shoulder area. This bursa is a fluid-filled sac (like a bubble) that provides a cushion between the acromion and the rotator cuff tendons. An inflammation of this bursa is called bursitis.
Impingement syndrome results in shoulder pain that can extend from the top of the shoulder to the elbow. In the beginning, the pain occurs whenever the arm is raised over the head. While the pain may not occur when the arm is at rest, it may flare up when sleeping because of pressure on the shoulder area. With time and repeated motion, the arm becomes weak, with little range of motion. Eventually, tiny tears in the fibers of the rotator cuff can progress to a larger tear in the tendon or even pull the tendon off the bone. Impingement syndrome is usually accompanied by shoulder tendonitis and bursitis.
Treatment for impingement syndrome begins with rest, ice packs, and anti-inflammatory medications. Ultrasound therapy may also be recommended to stimulate the tissues and improve blood flow. After the pain is gone, you will be able to begin stretching and strengthening exercises, as recommended by your doctor. Most patients see an improvement within 6 to 12 weeks. Some patients also benefit from a limited number of corticosteroid injections into the space under the acromion to reduce inflammation. If this treatment is not successful within 6 to 12 months, your doctor may recommend surgery to release the ligament, followed by physical therapy to gradually increase your range of motion. You may need to modify your physical activities to reduce the possibility of a relapse.
If conservative measures fail then surgery is indicated. The aim of keyhole surgery is to remove the cause of impingement. A small half centimeter hole is made at the back of the shoulder to introduce a telescope into the subacromial space. Initially any scar tissue that has formed here because of the inflammation and part the bursa is removed. This is carried out using an instrument known as a vaporiser, which burns the tissue away. Following this a shaver is introduced to take away excess bone at the acromion and the acromio clavicular joint. This increases the space and removes the causes of impingement