The word “impingement” covers a wide range of scenarios where something is pushing or causing pressure on another thing. In the shoulder, impingement most often refers to subacromial impingement, which affects the rotator cuff tendons beneath the acromion bone.
Impingement can cause persistent pain and affect daily activities. Symptoms are similar to rotator cuff tears, including pain when lifting the arm out to the side or overhead. That can include activities like reaching for a box of tissues behind the seat in the car, drying your hair, or reaching to get a plate out of an overhead cabinet. Impingement usually doesn’t result in weakness like a tear, but movement could be inhibited by pain.
Bone spurs in this area can also create pressure on the tendons and can eventually lead to rotator cuff tears. The shape of the acromion bone can be flat, curved, or hooked. People with more curvature in their acromion have a higher risk of rotator cuff tears as the acromion causes more wear on the rotator cuff over time.
That space around the rotator cuff tendons is relatively narrow, so any amount of inflammation in the shoulder can create pressure on the tendons and cause impingement, even in those individuals with a flat acromion. Sometimes the pain can radiate over the deltoid, but impingement pain usually stops above the elbow. If pain continues below the elbow and down into the hand, the problem likely originates in the neck rather than the shoulder area.
Impingement is usually treated with physical therapy, including specific exercises to strengthen the rotator cuff and scapular stabilizing muscles. For patients whose schedules or travel don’t allow for regular physical therapy appointments, many of the exercises can be done on your own using resistance bands, which can be rolled up and packed in a bag or suitcase.
Another treatment option is a steroid injection, which is a powerful anti-inflammatory that can help reduce swelling and pressure in the area. The steroid can take a few days to take effect, so the injection is typically done along with a local anesthetic that helps reduce the pain until the steroid can reduce the swelling.
Most of the time, surgery isn’t necessary for impingement alone. However, some patients with large bone spurs or those who don’t improve with non-operative treatments like physical therapy, injections, and anti-inflammatory medications may undergo an outpatient arthroscopic surgery. Through several small incisions, the surgeon can flatten the acromion bone, shave off bone spurs, and clean out the thickened bursa to relieve pressure and allow more room for the tendons.
If you are experiencing shoulder pain that affects your daily activity, contact the Oklahoma Shoulder Center today to schedule an appointment.
By Oklahoma Shoulder Center PLLC
December 15, 2017