From the Guidelines
Shoulder impingement is a condition where the rotator cuff tendons become compressed or irritated as they pass through the narrow space between the acromion and the head of the humerus, causing pain, inflammation, and limited mobility. This condition often develops due to repetitive overhead activities, poor posture, or structural abnormalities in the shoulder. The symptoms typically include pain when lifting the arm, especially overhead, and can lead to weakness and limited range of motion.
Key Points
- The condition can be caused by various factors, including repetitive overhead activities, poor posture, muscle imbalances, or structural abnormalities in the shoulder 1.
- Treatment usually begins with conservative measures, such as rest, ice, and anti-inflammatory medications.
- Physical therapy focusing on strengthening the rotator cuff muscles and improving shoulder mechanics is crucial for recovery and prevention of recurrence.
- If conservative treatments fail, corticosteroid injections may provide temporary relief, although the evidence for their effectiveness is conflicting 1.
- In persistent cases, surgery might be considered to create more space for the tendons by removing bone spurs or inflamed tissue. Some key considerations in managing shoulder impingement include:
- Early diagnosis and treatment to prevent further inflammation and damage to the rotator cuff tendons.
- A multidisciplinary approach, including physical therapy, medication, and potentially surgery, to address the underlying causes and symptoms of the condition.
- Patient education on proper shoulder mechanics, posture, and exercise techniques to prevent recurrence and promote long-term recovery.
From the Research
Definition of Shoulder Impingement
- Shoulder impingement, also known as shoulder impingement syndrome, is a condition where the rotator cuff tendons become compressed or pinched as they pass under the coracoacromial arch 2.
- This compression can lead to inflammation, pain, and limited mobility in the shoulder joint.
Causes of Shoulder Impingement
- The general pathology of subacromial impingement generally relates to a chronic repetitive process in which the conjoint tendon of the rotator cuff undergoes repetitive compression and micro trauma as it passes under the coracoacromial arch 2.
- Acute traumatic injuries may also lead to this condition 2.
Diagnosis and Treatment of Shoulder Impingement
- Diagnosis remains a clinical one, however advances in imaging modalities have enabled clinicians to have an increased understanding of the pathological process 2.
- Ultrasound scanning appears to be a justifiable and cost effective assessment tool following plain radiographs in the assessment of shoulder impingement, with MRI scans being reserved for more complex cases 2.
- A period of observed conservative management including the use of NSAIDs, physiotherapy with or without the use of subacromial steroid injections is a well-established and accepted practice 2.
- If surgery is to be performed, this should be done arthroscopically and in the case of complete rotator cuff rupture, the tendon should be repaired where possible 2.
Management of Shoulder Pain
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used for postoperative pain management, and have been shown to reduce opioid requirements and decrease patient pain levels in the first week after arthroscopic rotator cuff repair 3.
- Intra-articular steroid injections may be effective for reducing patients' pain and improving shoulder range of motion at 3 months postoperatively without compromising repair integrity 4.
- Acetaminophen and ibuprofen have been compared for the management of rotator cuff-related shoulder pain, with ibuprofen showing improvement in pain severity and functional activity, and acetaminophen showing improvement in the physical and environmental domains of quality of life scores 5.