Shoulder Impingement
What is Shoulder Impingement?
Shoulder impingement occurs when the rotator cuff tendons are pinched between the humeral head and the acromion, causing pain and inflammation.
- Compression of rotator cuff tendons
- Pain with overhead activities
Overview of the Condition
Also known as subacromial impingement syndrome, it can lead to rotator cuff tendinitis or tears if untreated.
Symptoms
- Shoulder pain during overhead motion
- Painful arc (60-120° of abduction)
- Night pain or difficulty sleeping on the affected side
Causes
Repetitive overhead activities, structural variations (hooked acromion), or rotator cuff weakness can cause impingement.
Diagnosis
Clinical exams (Neer’s and Hawkins’ tests) help identify impingement. Imaging may show acromial changes or bursal inflammation.
Treatment Options
- Physical therapy and NSAIDs
- Subacromial steroid injections
- Arthroscopic decompression in resistant cases
Conservative Management
Focuses on rotator cuff strengthening, scapular stabilization, and avoiding repetitive overhead activities.
Rehabilitation Exercises
- Pain-free range-of-motion exercises
- Rotator cuff strengthening (internal/external rotation)
- Scapular retraction and depressions
Surgical Options
Arthroscopic subacromial decompression to remove bone spurs and increase the subacromial space, reducing impingement.
Anatomy Overview
The subacromial space lies between the acromion and rotator cuff tendons. Narrowing here leads to impingement.
Affected Areas
- Subacromial bursa
- Rotator cuff tendons (especially supraspinatus)
Frequently Asked Questions
| Question | Answer |
|---|---|
| Does impingement always lead to a rotator cuff tear? | Not always, but chronic impingement increases the risk of rotator cuff tears. |
| How long is non-surgical treatment? | It varies, but 3-6 months of consistent therapy is common before considering surgery. |
Prevention Strategies
- Avoid repetitive overhead motions
- Perform regular rotator cuff and scapular exercises
- Maintain good posture to keep subacromial space open