Shoulder

Shoulder Impingement

The shoulder is one of the most versatile and mobile joints in the human body, consisting of several bones, muscles, tendons, and ligaments that enable a wide range of motion. However, this complexity also makes the shoulder prone to a variety of injuries and conditions. One such condition is shoulder impingement, a common cause of shoulder pain that can significantly impact daily activities and athletic performance.

What is Shoulder Impingement?

Shoulder impingement occurs when the tendons or the bursa in the shoulder are compressed or pinched by the bones, specifically the acromion (part of the shoulder blade) and the humerus (upper arm bone). This compression leads to inflammation, pain, and limited range of motion. The condition is most often associated with the rotator cuff tendons and subacromial bursa, which are structures that help stabilize and facilitate movement in the shoulder joint.

There are two primary joints in the shoulder:

  • Acromioclavicular (AC) Joint: Where the clavicle (collarbone) meets the acromion.
  • Glenohumeral Joint: Where the head of the humerus fits into the scapula (shoulder blade).
  • The rotator cuff—a group of four muscles and their associated tendons—holds the humeral head in place within the glenohumeral joint, enabling smooth movement and stability. When these tendons become irritated due to impingement, it can lead to pain and impaired function.

Symptoms of Shoulder Impingement

The primary symptom of shoulder impingement is pain, which can vary in intensity depending on the severity of the condition. Symptoms often start gradually and may include:

  • Mild pain during activity and rest.
  • Radiating pain from the front of the shoulder to the side of the arm.
  • Sharp pain during overhead or reaching movements, such as lifting or throwing.


As the condition progresses, the pain can become more persistent and severe, including:

  • Pain at night, especially when lying on the affected side.
  • Loss of strength in the shoulder, making lifting or carrying objects difficult.
  • Limited range of motion, particularly when performing activities like buttoning or zipping clothes behind your back.


Causes and Risk Factors

Shoulder impingement is most common in people who engage in overhead activities or sports that require repetitive shoulder motions. Young athletes, especially swimmers, baseball players, and tennis players, are particularly vulnerable to impingement due to the frequent overhead arm movements required in their sports.

Other common causes include:

  • Repetitive overhead motions: Activities like lifting, throwing, or swimming can irritate the rotator cuff and bursa.
  • Age-related changes: In middle-aged individuals, wear and tear on the shoulder joint may lead to the development of bone spurs or narrowing of the space beneath the acromion, causing impingement.
  • Previous injuries: Minor injuries or previous shoulder strains can increase the likelihood of developing impingement.


Risk factors for shoulder impingement include:

  • Poor posture: Rounded shoulders or a forward head position can alter shoulder mechanics and increase the risk of impingement.
  • Weak rotator cuff muscles: Weak or imbalanced shoulder muscles may fail to stabilize the shoulder properly, leading to impingement.
  • Tightness of the shoulder muscles or tendons, particularly in the upper back, may contribute to shoulder impingement by restricting proper movement and space within the joint.


Diagnosis of Shoulder Impingement

Diagnosis of shoulder impingement is based on a detailed medical history, physical examination, and imaging tests. Dr. Ryan du Sart will perform an assessment of the shoulder joint, including palpating the area for tenderness, and performing special tests to assess the range of motion, strength, and stability of the joint.

Imaging tests may include:

  • X-rays: These help identify bone spurs or narrowing of the subacromial space that might be causing impingement.
  • MRI: Magnetic resonance imaging provides detailed images of soft tissue structures, such as the rotator cuff tendons and bursa, allowing Dr. du Sart to assess inflammation, tears, or other damage.
  • Ultrasound: This may be used to visualize soft tissues and detect inflammation or damage in the shoulder tendons.


Treatment Options for Shoulder Impingement

Shoulder impingement can often be managed with non-surgical treatments. However, if conservative measures are unsuccessful, surgery may be considered.


Non-Surgical Treatment

For many patients, non-operative treatment is effective in reducing pain and restoring function:

  • Rest and activity modification: Avoid activities that cause pain or aggravate symptoms. Limiting overhead or repetitive motions is critical for recovery.
  • Pain relief: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, or paracetamol, can be used to reduce pain and inflammation.
  • Physical therapy: A structured rehabilitation program focusing on stretching, strengthening the rotator cuff muscles, and improving posture can help reduce impingement. Exercises that focus on increasing shoulder flexibility and restoring normal movement patterns are essential for long-term recovery.
  • Corticosteroid injections: In some cases, an injection of corticosteroids into the subacromial space may provide temporary relief by reducing inflammation.


Surgical Treatment

If non-surgical treatment fails to improve symptoms or if the condition is severe, surgery may be recommended. Surgical options for shoulder impingement typically involve:

  • Shoulder Arthroscopy: This minimally invasive procedure uses small incisions and a tiny camera (arthroscope) to visualise and treat the damaged structures within the shoulder joint. During surgery, the inflamed bursa is removed, and any bone spurs or damaged portions of the acromion may be shaved down to create more space and reduce pressure on the rotator cuff.


Advantages of Shoulder Arthroscopy include:

  • Minimally invasive: Smaller incisions, less scarring, and faster recovery.
  • Quicker recovery time: Patients typically experience less postoperative pain and return to activity sooner compared to traditional open surgery.


Recovery and Rehabilitation

Recovery from shoulder impingement surgery depends on the extent of the procedure and the individual’s overall health. Rehabilitation is critical to restoring function and preventing future injury. Key components of the recovery process include:

  • Post-operative care: Ice and elevation can help reduce swelling and pain after surgery. Pain medications will be prescribed to manage discomfort.
  • Physical therapy: After surgery, physical therapy will focus on restoring shoulder strength, flexibility, and range of motion. Exercises will be tailored to the patient's needs and progress.
  • Gradual return to activity: High-impact or overhead activities should be avoided for several months to allow proper healing. Dr. du Sart will provide a personalised rehabilitation program to ensure optimal recovery.


Why Choose Dr. Ryan du Sart?

Dr. Ryan du Sart is a fellowship-trained orthopaedic surgeon with extensive experience in diagnosing and treating shoulder impingement. He utilizes advanced imaging and diagnostic techniques to develop a tailored treatment plan for each patient, ensuring the best possible outcome.


Book a Consultation

If you are experiencing shoulder pain or think you may have shoulder impingement, early diagnosis and intervention are key to preventing further damage. Contact Dr. Ryan du Sart’s office today to schedule a consultation.

Phone: (08) 9779 9767
Email: admin@ryandusart.com.au

Clinic Locations:

6 Higgins Street, South Bunbury, WA 6230

20 Prince Street, Busselton, WA 6280



References:

  1. Cohen, S. P., et al. (2016). "Shoulder impingement syndrome and the management of rotator cuff disorders." Journal of Shoulder and Elbow Surgery, 25(4), 1-14.
  2. Madhav, R., et al. (2020). "Evaluation and management of shoulder impingement syndrome." The Journal of Bone and Joint Surgery, 102(2), 126-132.
  3. Buchbinder, R., et al. (2017). "Rotator cuff disease and shoulder impingement syndrome: Conservative management." Cochrane Database of Systematic Reviews.