ValleyOrtho’s physicians treat a wide range of common shoulder injuries, including impingement syndrome.
About
Impingement is a common overuse injury in sports such as baseball, softball, tennis, golf and swimming. This common shoulder disorder is caused by improper alignment of the bones and tissues in the upper arm. The rotator cuff tendons, the biceps tendon and subacromial bursa may be inflamed from repetitive microtrauma when the upper arm bone and tip of the shoulder blade get “impinged” or pinched together.
If the rotator cuff becomes inflamed from overuse, the space between the upper arm bone and tip of the shoulder blade is narrowed. This causes the rotator cuff and its fluid-filled bursa to pinch together. This impingement results in irritation and pain when the shoulder is raised.
Causes
Shoulder impingement may occur with:
- Long term repetitive overhead activities that may occur with specific sports or jobs
- Sudden increases or changes in overhead activities
- Tight shoulder muscles or joint capsule causing limitation of shoulder motion
- Fatigue of shoulder muscles during prolonged overhead activities
- Trauma to the shoulder area that results in inflammation
Symptoms
Shoulder impingement includes the following signs and symptoms:
- Pain in the front or on the top of the shoulder during and/or after overhead activity
- Pain when reaching overhead in only the middle portion of the movement.
- Shoulder weakness with overhead activity
- Night pain that may cause one to wake up while sleeping
Diagnosis
A thorough history review, physical exam and type of symptoms help determining the source of shoulder pain. If necessary an X-Ray can show any bony changes that may impact your recovery. Or an MRI may be ordered to provide a detailed, high-resolution image of bones, joints, tendons, ligaments and muscles. It helps us understand how extensive the damage or abnormality is and if surgery is potentially required.
Treatment
The majority of shoulder injuries respond to a nonsurgical approach, but if symptoms worsen, surgery might be a solution to consider.
Conservative Treatment
- Decreasing, modifying or stopping overhead activities
- Stretching and warming up prior to activity
- Icing after activity for 15 to 20 minutes
- Referral to a physical therapist for:
- Exercises to optimize posture, flexibility, strength and movement patterns
- Joint mobilizations to improve joint flexibility and mechanics
- Anti-inflammatory medication
- A cortisone injection into the area of inflammation
- A PRP injection to increase healing of the tissue
Surgical Treatment
If conservative treatment is not successful in improving symptoms, surgical intervention may be considered. A shoulder arthroscopy can address the various causes of shoulder impingement and the procedure may include:
- Subacromial decompression: The acromion is shaved down to make more room for the rotator cuff to decrease the pinching and irritation
- Biceps tenodesis: The biceps tendon is cut and reattached to the upper part of the humerus
- Debridement: Removal of any inflamed tissue that may be causing pain and pinching in the joint
With advanced training, a wealth of experience and the latest in equipment and techniques, ValleyOrtho’s physicians work with our patient’s entire health care team to ensure a safe and complete recovery.