Shoulder Impingement

Shoulder impingement syndrome is a painful condition where the tendons of the rotator cuff muscles become trapped or compressed and irritated during shoulder movements and rub between the upper arm bone and the acromion, the top of the shoulder blade where it connects with the collarbone. Shoulder impingement is the most common diagnosis for shoulder pain.

The repeated friction causes irritation, pain and swelling of the rotator cuff tendons (tendinitis) and inflammation of the bursae, which narrows the space available for the tendons and causes pinching when the arm is raised overhead. Impingement occurs in sports like volleyball, baseball, swimming, and tennis, but can also occur when reaching behind to zip up a dress or sleeping with the arms out to the sides above the head.

Subacromial bursitis is related to shoulder impingement and is similarly due to compression between the bones. Specifically, it is due to the undersurface of the acromion bone rubbing against the bursa. The bursa is a fluid-filled sack that protects your rotator cuff tendon, but it can become inflamed and painful. The underlying rotator cuff may or may not be involved in this condition.

Shoulder impingement occurs when there is increased pressure on the rotator cuff tendons and bursa as they pass through the space below the shoulder blade (acromion). Several factors can lead to this pressure:

• Repetitive arm movements, especially overhead activities, can irritate or damage the tendons and bursa. Overuse is the most common cause.
• Bone spurs (tiny bone growths) from arthritis or variations in bone shape can reduce the space under the acromion, squeezing the tendons and bursa.
• Weakness or imbalance in the shoulder muscles can cause improper shoulder movements, leading to increased rubbing or pinching of the tendons.
• Age and poor posture contribute to the development of shoulder impingement syndrome.
• When the tendons are pinched, they can become inflamed and swollen, which further narrows the space and increases the impingement. This cycle can lead to pain and reduced movement in the shoulder.

Symptoms typically include:

• Pain that develops gradually or suddenly.
• Pain when lifting the arm, especially overhead.
• Pain that radiates from the shoulder to the outside of the upper arm.
• Pain that comes and goes.
• Pain that worsens at night and can interfere with sleep.
• Swelling and tenderness in the shoulder.
• Decreased strength and range of motion.
• Pain when lying on the affected shoulder.

Shoulder impingement can significantly impact daily activities and quality of life due to the discomfort and limitation in shoulder movement it causes.

Dr. Kaplan will review your medical history, inquire about your pain, the causes of your  your pain, and risk factors you have such as age, structural issues and repetitive activities.  He will perform a thorough physical exam palpating for tenderness and swelling and use specific tests to trigger the pain to confirm a diagnosis. He will also check range of motion and strength and evaluate your posture.

Imaging tests such as X-rays can be used to rule out other causes of shoulder pain and identify any bone spurs or anatomical abnormalities. Ultrasound or magnetic resonance imaging (MRI) may be employed to assess the condition of the rotator cuff tendons, the presence of inflammation in the bursa, or other soft tissue injuries.