Impingement

Overview

When you raise your arm to shoulder height, the space between the acromion and rotator cuff narrows. The acromion can rub against (or "impinge" on) the tendon and the bursa, causing irritation and pain.

Young athletes who use their arms overhead for swimming, baseball, and tennis are particularly vulnerable. Adults who do repetitive lifting or overhead activities using the arm, such as construction or painting, are also susceptible. Pain may also develop as the result of a minor injury.

Symptoms of impingement include:

• Minor pain that is present both with activity and at rest
• Pain radiating from the front of the shoulder to the side of the arm
• Sudden pain with lifting and reaching movements
• Loss of strength and motion

Diagnosis

As part of the physical examination, your doctor will likely conduct some range of motion and strength tests. Your doctor will check for other problems with your shoulder joint. They may also examine your neck to make sure that the pain is not coming from a "pinched nerve" and to rule out other conditions.

X-rays or magnetic resonance imaging (MRI) may also help determine whether you have shoulder impingement.

Treatment Options

Treatment for shoulder impingement begins with resting the affected shoulder and modifying your activities to avoid moving the joint in a way that causes pain. Your doctor may also recommend physical therapy to strengthen the muscles that support the shoulder or anti-flammatory and pain medications. If these treatments do not relieve pain, your doctor may recommend shoulder impingement surgery.

The goal of surgery is to create more space for the rotator cuff. To do this, your doctor will remove the inflamed portion of the bursa and often a portion of the bone putting pressure on the tissue. This is known as a subacromial decompression. These procedures are usually performed using a scope and instruments through many small incisions around the shoulder.

Physical Therapy

Your doctor may recommend physical therapy to help you regain strength and to restore range of motion.