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What Is Impingement Syndrome?

If you've noticed shoulder pain when raising your arm, you may have impingement syndrome.  This is pinching within your shoulder.  The problem may have been caused by repeating an overhead motion. 

What are the Symptoms?
Pain, pinching, and stiffness in your shoulder when raising your arm are common symptoms of impingement.  In some cases, you may feel a nagging pain even when you're not using your shoulder.

Who Gets Impingement?
People with impingement are often young women and men who make repeated overhead movements.  These movements can cause a repetitive motion injury (RMI).  An RMI may occur when a forceful action is repeated day after day without resting.  Some activities that may lead to RMI are:

  • Warehouse or shipping
  • Painting or carpentry
  • Swimming, tennis, softball, and
    other sports
  • Weekend home repair
Impingement also may occur if one of your shoulder bones is shaped a certain way.  In some cases, older people may get impingement after years of normal shoulder use.

How Is Impingement Diagnosed?

Our doctors will carefully examine your shoulder.  He or she also may do some of the following tests:

  • Impingement Sign Test.  You slowly raise your arms as your doctor guides them.  Point out to him when you begin to fell pain.
  • Strength Test.  With your arms raised, the doctor gently presses down on them while you try to resist.
  • X-rays.  X-ray  images of your shoulder can show whether bone shape is causing impingement.  X- rays can also rule out problems other than impingement.
  • Other Test.  Magnetic resonance imaging (MRI), arthrograms, or an injections can help your doctor learn whether you have impingement.

How Is Impingement Treated?
Rest is the first treatment for impingement.  If an activity hurts, don't do it.   Otherwise, you prevent healing and increase pain.  Work with your doctor to treat the pain.  There are other treatments which include:

  • Ice, heat, and medication
  • Physical Therapy
  • Exercises
  • Injection therapy
  • Surgery (as a last resort)

 

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Your Shoulder In Motion
Many bones, muscles, and tendons in your shoulder let you reach, swing, and lift.  A group of muscles and tendons, called the rotator cuff, allows all the parts to work together.  As you raise your arm, the narrow space within the shoulder joint naturally compresses.  Over time, this may irritate a muscle or tendon, leading to swelling.  The swelling may then narrow the space more, causing pinching and impingement.

 

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 A Normal Shoulder
Acromion (top back part of the shoulder blade), Coracoacromial ligament )fibrous connected tissue that extends to the coracoid process), Bursa (flat membrane that keeps shoulder parts from rubbing against each other), Supraspinatus (tendon and muscle that help form the rotator cuff), Long biceps tendons (Fibrous connective tissue that attaches biceps muscle to shoulder blade), Humerus (upper arm bone), Coracoid process (from part of the shoulder blade),  Clavicle (collarbone), Scapula (shoulder blade).


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When Shoulder Problems Begin

Repeated overhead shoulder movement can cause aching and inflammation (swelling) in your shoulder.  If you keep using your shoulder, the pain can worsen.  A number of things can then set the impingement cycle in motion.
Overuse
Continuing shoulder use without allowing time to rest can lead to swelling and pinching of tendons and the bursa		 Acromion Shape
A hooked acromion can press down on the tendons and the bursa, adding to irritation and causing inflammation		 Other Causes
Wear and tear can cause instability (strained shoulder ligaments that lead to looseness and swelling.
 

How Impingement Develops

Impingement can take time to develop.  At first, you may feel a minor pain in your shoulder tendons.  These tough strands of fibrous tissue connect muscle to bone.   As the tendons become irritated, your body sends more blood to the area.  This causes inflammation, which narrows the space even more.  This inflammation is called tendinitis.

If you don't rest your shoulder, you may trigger another problem.  The bursa, normally a flat membrane, fills with fluid.  This is called bursitis.  It causes more swelling and compression within the shoulder joint.

Both tendinitis and bursitis decrease the space within your shoulder joint.  You may feel a painful pinching when you use your shoulder.  And if you don't allow time to heal, impingement pain can increase.

Your Role in Healing
Rest.  That's the best way to start healing.  But in this case, rest means limiting - not eliminating - shoulder motion.  This is called active rest.  Once you can get back to your normal activities, you may then change your shoulder movements to help prevent future problems.

Balancing Rest and Motion
Dr. Kalbac will give you information on exercises and activities to balance rest and motion.

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Treatment Options for Pain
Impingement can be treated a number of ways.  We will discuss treatment options with you.  Many steps can be taken to relieve pain on your own at home.  But in some cases, you may need treatment that requires the doctor's help.

Finding the best treatment for you
Ice, heat, and medication can help relieve shoulder pain quickly.  But if your pain continues, call us.  Keep in mind that no two people are alike.  You may need to try a few pain relief methods before you find the best one for you.  We will help you choose.
Ice
Ice reduces inflammation and relieves pain.  Apply an ice pack for about 15 min. at a time, 2 0r 3 times a day.  You can also use a bag of frozen peas instead of an ice pack.  The bag will mold nicely into the shape of your shoulder.  A pillow placed under your arm may make you more comfortable.		 Heat
Heat may soothe aching muscles, but it won't reduce inflammation.. you can use a heating pad or take a warn shower or bath.  Do this for 10 minutes at a time. NOTE: Avoid heat when first injured.  Heat is best used for warming up before an activity. 		Medication
Try over-the-counter pain relievers.  Aspirin, ibuprofen, or naproxen can help reduce pain and inflammation.  The doctor also may prescribe pain relievers.  He will discuss what to take and how much, and when.  Be sure to follow all instructions.
Electrical Stimulation
Electrical Stimulation can help reduce pain and inflammation.  The doctor attaches small pads to your shoulder.  A mild electric current then flows into your shoulder.   You may feel tingling, but it doesn't hurt.  This treatment is often done 3 times a week for 10-20 minutes at a time.		 Ultrasound
Ultrasound can reduce pain.  Your health care provider applies a slick gel or a medicated cream to your shoulder.  Then he rubs a small device over the area.   Sound waves from the device help loosen tightness.  Ultra sound is painless.   It's often done 3 times a week for 4 to 8 minutes at a time.		 Injection
You may have an injection if other pain relief doesn't work.  The doctor numbs a small spit on the shoulder.  He then injects some cortizone (an anti-flammatory medicine) into the shoulder.  It can take a few hours or even a couple of days before injection helps.  But the effect can last for weeks.
After Diagnosis and a treatment plan is determined.  Our office will give some exercises and stretches you can do at home to increase shoulder flexibility and strength.

 

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If You Need Surgery
If your symptoms aren't relieved by other treatment, you may need surgery..Surgery creates space where impingement has caused narrowing within your shoulder.  In most cases, the procedure is done arthroscopically.  This technique uses tiny incisions, speeding your recovery.

Ask Doctor Kalbac or the nurse for tips on preparing for your surgery.
Risks and Complications
Like any surgery, arthroscopic shoulder surgery has certain risks and possible complications.  We will explain them to you.  Some of them include:

  • Infection
  • Damage to nerves or blood vessels
  • Loss of flexibility

Giving your Shoulder Space to Move
Surgery for impingement helps free up space within your shoulder.  This allows pain-free motion.  The surgery is often done in 3 steps.  You probably can go home the same day you have the surgery.

Step 1.  The swollen, inflamed bursa is removed.
Step 2.  The coracoacromial ligament is cut
Step 3.  A small portion of the acromoin is shaved off.

As You Recover
You will be taken to a recovery area after surgery.  A doctor or nurse will give you medicine to help relieve discomfort.  Before leaving the surgery center, make sure you know how to care for yourself at home.  Taking medicine, using ice, and keeping your arm in a sling as instructed will help you recover faster.  It may take a few months before your shoulder is fully healed.

When to Call Dr. Kalbac's Office
After surgery, it's normal to feel some shoulder numbness for the first few days.   But call us if you notice any of the following:

  • Excessive pain or swelling
  • Excessive drainage from the wound
  • Numbness in your fingers or hand
  • Increased redness near an incision
  • Fever or high temperature

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