Shoulder Impingement

What is a Shoulder Impingement?

Shoulder impingement occurs when the tunnel between acromion process off of the shoulder blade and the humeral head is small or the structures that run through the tunnel are inflamed.  The tunnel is known as the subacrimial space.  The structures that become inflamed are the subacromial bursa, supraspinatus muscle, and/or biceps tendon (long head).  The subacromial bursa is a fluid filled sac that prevents wear and tear of muscle tendons as they move around a bone.  The supraspinatus muscle is the main rotator cuff muscle that originates on the top of the scapula (shoulder blade), runs under the clavicle (collar bone), and inserts on the humeral head.  The biceps tendon can pinch between the clavicle and humeral head.  Impingement injuries commonly occur in patients that participate in overhead activities (working on ceiling fixtures, throwing motions).  Overuse leads to inflammation causing a pinching pain when the arm is lifted above the head or brought across the front of the body.

Shoulder Diagram

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How is Shoulder Impingement diagnosed?

Shoulder impingement is a clinical diagnosis based on history and physical exam.  Special tests that are used for diagnosing shoulder impingement include Neer’s, Hawkins-Kennedy, and Speed’s tests.  Diagnostic testing may include x-rays or MRI to help rule out involvement of surrounding structures or other injury.

How is Shoulder Impingement treated?

Conservative treatment typically includes anti-inflammatory medication, physical therapy, and possibly a steroid injection (intra-articular corticosteroid injection) in the subacromial joint space.  Range of motion is limited so that movement of the shoulder is pain free.  The patient may be limited, not permitting the patient to lift their arm above shoulder level.  Lifting the arm above shoulder level pinches the anatomic structures leading to inflammation preventing resolution of impingement.

Subacromial Space Shoulder Diagram

Is surgery required for Impingement?

Surgery is not required for impingement.  However, if conservative treatment fails, and the patient is still having significant pain, elective surgery may be the next option.  Surgical options include a distal clavicle resection, subacromial decompression, and/or bursectomy, all of which are arthroscopic procedures.  Distal clavicle resection removes a piece of bone from the clavicle; this allows an increase in size of the space below the clavicle decreasing pressure on the underlying anatomy.  Subacromial decompression removes the undersurface bone from the acromion, which may include bone spurs (increased calcium formation).  This procedure opens the subacromial space allowing the biceps, supraspinatus, and bursea to move freely without friction, thus preventing inflammation.  A bursectomy is the removal of a bursea sac;  for impingement, the subacromial bursea is removed.

Distal Clavicle Resection

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What are my restrictions after Impingement Surgery?

Patients will be immobilized with the use of a post-operative sling immediately following surgery.  The sling is provided to decrease stress on the shoulder while healing occurs, as well as aid in decreasing soreness.  Physical therapy will start within the first week following surgery, beginning with simple range of motion exercises and basic strengthening techniques.  A patient can expect to be removed from the sling within 4 weeks of surgery, and have normal range of motion within 3 months.  Pain is the most limiting factor following surgery for impingement

What are the risks of Impingement Surgery?

All surgeries have associated risks.  Luckily, impingement surgery has few complications and the benefits typically outweigh the risks.  Common risks and complications include bleeding, infection, swelling in the elbow/wrist/hand, and numbness/tingling in the elbow/wrist/hand.

See if you’re dealing with shoulder impingement and what the next steps are, by scheduling an appointment with Dr. Robert Rolf.