What is the treatment for shoulder impingement?

From the Guidelines

Treatment for shoulder impingement should prioritize a combination of rest, activity modification, physical therapy, and medications, with surgery considered only after 6 months of conservative management. When managing shoulder impingement, it's crucial to initially reduce activities that exacerbate pain and avoid overhead movements.

• Physical therapy is a cornerstone, focusing on strengthening the rotator cuff muscles and improving scapular stability through exercises like external rotation with resistance bands, scapular retraction, and posterior capsule stretching.
• Medications such as ibuprofen (400-800mg three times daily) or naproxen (250-500mg twice daily) can be used for short periods (1-2 weeks) to reduce pain and inflammation.
• Ice application to the shoulder for 15-20 minutes several times daily can also help in managing pain. The use of corticosteroid injections for durations between 2 and 6 weeks has shown conflicting results in terms of pain and function outcomes, as reported in five level II studies 1. Given the conflicting evidence regarding the effectiveness of subacromial corticosteroid injections, the decision to use them should be made on a case-by-case basis, considering the potential benefits and risks for each patient. Most cases of shoulder impingement resolve with conservative treatment within 3-6 months, and thus, surgery (subacromial decompression) is only considered if symptoms persist despite 6 months of appropriate conservative management. This approach aims to reduce inflammation, strengthen supporting muscles, and improve biomechanics to decrease pressure on the impinged structures, ultimately improving morbidity, mortality, and quality of life outcomes for patients with shoulder impingement.

From the Research

Treatment Options for Shoulder Impingement

The treatment for shoulder impingement syndrome can be categorized into conservative and surgical methods.

• Conservative treatment includes physical therapy, anti-inflammatory medications, and injections 2.
• Surgical treatment is reserved for refractory cases and includes decompression, debridement, and/or repair of injured structures 2.

Conservative Treatment

Conservative treatment typically begins with nonsteroidal anti-inflammatory drugs and physical therapy, and can include subacromial injection of corticosteroids 3.

• The heated lidocaine/tetracaine patch has been reported to reduce shoulder impingement syndrome pain, with similar efficacy to subacromial corticosteroid injections 3.
• Kinesiotaping and subacromial corticosteroid injection have been found to provide additional benefit when used with nonsteroidal anti-inflammatory drugs in patients with shoulder impingement syndrome 4.
• Subacromial corticosteroid injections have been found to reduce pain and improve function for up to 6 months, with no significant difference between anterior and posterior injection routes 5.

Comparison of Treatment Options

A systematic review and meta-analysis found that corticosteroid injections and physiotherapy have similar effects on pain, shoulder range of motion, and shoulder function in patients with subacromial impingement syndrome, except for a short-term significant improvement in shoulder function in favor of corticosteroid injections 6.

• The choice of treatment should be based on individual patient needs and clinical acumen, as both conservative and surgical options have their own benefits and drawbacks 2, 3, 4, 5, 6.