Impingement Syndrome

The shoulder is a ball and socket joint. The rotator cuff is a series of four separate muscles (1: supraspinatus, 2: infraspinatus, 3: teres minor, 4: subscapularis) that converge together and pass over the shoulder joint much like the cuff of a shirt sleeve passes over your wrist.

The rotator cuff passes underneath a bony arch (the acromion) of the shoulder blade and attaches to the ball (the humerus bone) of the ball and socket joint. In impingement syndrome, the tendon of one of the muscles of the rotator cuff (the supraspinatus) gets pinched (or impinged upon) by the bony arch of the shoulder blade and the ball of the humerus. This creates inflammation in the tendon (tendonitis) and overlying bursa (bursitis), and may create some fraying or partial-thickness tearing of the rotator cuff.

Impingement syndrome can occur due to bone spurs on the arch of the shoulder blade or due to improper mechanics of the muscles that control the shoulder blade or the muscles of the rotator cuff.

Signs & Symptoms:

Patients typically report a history of gradually worsening shoulder pain; the pain is typically located on the front and outside part of the shoulder. Usually there is no history of an acute injury. The pain is often worse with certain movements, including reaching overhead, reaching behind the back, and lifting objects away from the body. In addition, the pain is often worse at night and may awaken the patient from sleep.

Diagnosis:

The diagnosis of impingement syndrome is typically made by a combination of the patient’s history, the findings on physical examination, and x-rays. An MRI scan may confirm the diagnosis.

Treatment:

The treatment of impingement syndrome is usually non-operative initially. Typically a conservative treatment approach including anti-inflammatory medications, physical therapy, and possibly a steroid injection is recommended.

If this conservative approach fails, surgery may be considered. During surgery, the inflamed bursa is excised and bone spurs on the arch of the shoulder blade are removed

Jarrod Smith, MD

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Shoulder Impingement

Jarrod Smith, MD