Impingement Syndrome

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Impingement Syndrome is a common condition affecting the shoulder often seen in aging adults. This condition is closely related to shoulder bursitis and rotator cuff Tendinitis. These conditions may occur alone or in combination.

When an injury occurs to the rotator cuff muscles, which encase the shoulder joint, they respond by swelling. However, because the rotator cuff muscles are surrounded by bone, when they swell a series of other events occur.

The pressure within the muscles increases, which results in compression and loss of blood flow in the small blood vessels. When the blood flow decreases, the muscle tissue begins to fray like a rope. Motions such as reaching up behind the back or reaching up overhead to put on a coat or blouse, for example, may cause pain.

Symptoms:

Pain with overhead activities

Pain while sleeping at night

Pain over the outside of the shoulder/upper arm

Impingement syndrome and a rotator cuff tear are different problems, and although they are related, the treatment is different. Impingement syndrome is a problem of inflammation around the rotator cuff tendons. A rotator cuff tear is an actual tear within the tendons. The best signs that differentiate these problems area the strength of the rotator cuff muscles. Your orthopedic doctor will be able to specifically isolate these muscles to better determine if a rotator cuff tear is present. A MRI can also show the tendons of the rotator cuff and help determine if a tear is present.

Causes:
Usually, there is enough room between the acromion and the rotator cuff so that the tendons slide easily underneath the acromion as the arm is raised. But each time you raise your arm, there is a bit of rubbing or pinching on the tendons and the bursa. This rubbing or pinching action is called impingement.

Impingement occurs to some degree in everyone's shoulder. Day-to-day activities that involve using the arm above shoulder level cause some impingement. Usually it doesn't lead to any prolonged pain. But continuously working with the arms raised overhead, repeated throwing activities, or other repetitive actions of the shoulder can cause impingement to become a problem. Impingement becomes a problem when it causes irritation or damage to the rotator cuff tendons. Raising the arm tends to force the humerus against the edge of the acromion. With overuse, this can cause irritation and swelling of the bursa. If any other condition decreases the amount of space between the acromion and the rotator cuff tendons, the impingement may get worse.

Bone spurs can reduce the space available for the bursa and tendons to move under the acromion. Bone spurs are bony points. They are commonly caused by wear and tear of the joint between the collarbone and the scapula, called the acromioclavicular joint. The AC joint is directly above the bursa and rotator cuff tendons.

In some people, the space is too small because the acromion is oddly sized. In these people, the acromion tilts too far down, reducing the space between it and the rotator cuff.

Treatment:
Oral anti-inflammatory medications—such as aspirin, naproxen or ibuprofen, remain the most common treatment for impingement syndrome.

You must consistently take the medication for nearly eight weeks for it to be effective. You should do this under the care of a doctor because these medications can cause stomach irritation and bleeding.

Taking anti-inflammatory medications for a short period of time may treat the symptom of pain, but it will not treat the underlying problem and symptoms will come back. There is no specific medication for this condition and response to any given medication differs from person to person. If one anti-inflammatory medication does not help within 10 to 14 days, then another one will be given until one that provides relief is found.

In addition to taking medications, daily stretching in a warm shower will help. Work to reach your thumb up and behind your back. Avoid repetitive activities with your injured arm, particularly where the elbow would move above shoulder level. Avoid vacuuming, painting, raking leaves and washing the car. Your physician may refer you to a physical therapist who can demonstrate the exercises most effective in strengthening and stretching the shoulder muscles.

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...less medical jargon in a 'Quick Glance' format!