From the Guidelines
Shoulder impingement is a common condition where the tendons of the rotator cuff become compressed or irritated as they pass through the narrow space between the acromion and the head of the humerus, typically causing pain when raising the arm, especially between 60 and 120 degrees. This condition can lead to inflammation, weakness, and reduced range of motion. The most recent and highest quality study on this topic is not directly provided, but based on the available evidence, treatment usually begins with conservative measures including rest, ice, anti-inflammatory medications like ibuprofen, and physical therapy focusing on strengthening the rotator cuff muscles and improving shoulder mechanics 1. Some key points to consider in the management of shoulder impingement include:
- The use of imaging studies such as MRI, MR arthrography, and ultrasound to evaluate the shoulder joint and surrounding structures 1
- The importance of proper diagnosis to rule out other causes of shoulder pain, such as instability, cervical disk disease, and acromioclavicular joint disease 1
- The potential benefits of corticosteroid injections for persistent pain, as well as surgical intervention in severe or persistent cases 1 It's worth noting that the evidence provided does not include a recent, high-quality study that directly addresses the question of shoulder impingement. However, based on the available evidence and general medical knowledge, the recommended treatment approach for shoulder impingement prioritizes conservative measures, with a focus on reducing pain and inflammation, improving range of motion, and strengthening the surrounding muscles.
From the Research
What is Shoulder Impingement?
Shoulder impingement, also known as shoulder impingement syndrome, occurs when the tendons of the shoulder joint are intermittently trapped and compressed during shoulder movements. This can lead to pain and limited mobility in the shoulder.
Causes and Symptoms
- The condition is often caused by a structural narrowing in the subacromial space, which can be due to various factors such as bone spurs, inflammation, or poor posture 2.
- Symptoms include painful entrapment of soft tissue when elevating the arm, and can be diagnosed through a combination of history, physical examination, and imaging tests such as x-ray, ultrasound, and MRI 2.
Treatment Options
- Conservative treatment, including nonsteroidal anti-inflammatory drugs, infiltrations, and patient exercises, can yield satisfactory results in 60% of cases within 2 years 2.
- Manual physical therapy (MPT) has been shown to be an effective treatment option, with studies demonstrating significant improvements in pain and disability in patients with shoulder impingement syndrome 3, 4.
- Exercise therapy, including shoulder strengthening exercises, is also a recommended treatment option, with evidence suggesting that it can improve functionality and reduce pain in patients with shoulder impingement syndrome 5, 6.
Comparison of Treatment Options
- A study comparing the effectiveness of subacromial corticosteroid injection (CSI) and MPT found that both groups demonstrated approximately 50% improvement in shoulder pain and disability index scores at 1 year, with no significant difference between the two groups 4.
- Another study found that patients receiving CSI had more shoulder impingement syndrome-related visits to their primary care provider and required additional steroid injections, whereas patients receiving MPT used less healthcare resources 4.