What is Impingement Syndrome?
Impingement disorder, also known as rotator cuff tendinitis or subacromial Impingement disorder, occurs when the tissues beneath the acromion bone (such as the tendons of the rotator cuff muscles or the bursa) become squeezed or "impinged". This condition is a common source of shoulder pain. The rotator cuff is made up of four muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) that act to rotate and stabilize the shoulder joint. Their tendons run under the acromion and help hold the humeral head (ball portion of the upper arm bone) in the shoulder socket during movement.
Causes of Impingement Syndrome
There are a few main factors that can lead to impingement:
Bony changes: When the acromion bone develops bone spurs or deformities it can reduce the available space for the rotator cuff tendons. This puts added pressure on the tissues.
Calcium deposits: Calcium deposits in the tendons (tendinosis) or around the bursa can further narrow the space beneath the acromion.
Postural problems: Impingement Syndrome Poor posture with rounded shoulders puts the shoulders in a position of greater impingement over time. Excessive computer use or other tasks with arms elevated can exacerbate posture problems.
Overuse/repetitive strain: Frequent reaching, lifting or other repetitive overhead motions can traumatize the tendons leading to inflammation and swelling. Sports like swimming and tennis often trigger overuse injury.
Injury history: Prior injuries or dislocations that were not properly rehabilitated can increase risk through residual mechanics abnormalities, tendon damage or capsular tightness.
Aging: As we age, the tissues in the shoulder naturally lose elasticity making them more susceptible to injury from impingement or overuse. Calcium deposit buildup also becomes more common.
Risk Factors for Developing Impingement disorder
Certain risk factors increase one's chances of developing Impingement disorder:
- Age over 40: Incidence rises with aging as tissues thin and become less elastic.
- Occupation involving overhead work: Construction work, painting, assembly line jobs are high risk.
- Repetitive shoulder motions in sports: Swimming, tennis, baseball/softball pitchers are very susceptible.
- Previous shoulder dislocations or fractures: Injury history causes persistent mechanics issues.
- Diabetes: Higher risk of tendon degeneration and poor healing response.
- Family history: Genetic predisposition seems to play a role in some cases.
- Obesity: Excess weight puts added strain on shoulder joints and tissues.
- Poor posture: Rounded shoulders keep the rotator cuff muscles in a constantly compromised position.
Symptoms of Impingement disorder
Those experiencing Impingement disorder will typically feel one or more of the following:
- Pain at the front or side of the shoulder that is worsened with overhead activities
- Tenderness when pressure is applied just behind and above the shoulder point
- A grinding or crunching sensation with certain arm movements
- Pain that travels down the arm, especially at night
- Limited range of motion, especially lifting the arm behind the back or head
-Weakness, especially with overhead motions or lifting
-Catching, popping or sticking sensations in the shoulder
-Possible referred pain or numbness into the neck or upper arm regions
The severity of symptoms will vary depending on factors like the degree of tissue damage, presence of bone spurs or calcium deposits, overuse history, posture and individual pain tolerance level. For some the pain is minor and comes on only with certain motions, while others have constant significant discomfort at rest.
Diagnosing Impingement disorder
To accurately diagnose Impingement disorder, your doctor will perform a thorough physical exam and assessment. They will check range of motion, strength and look for specific provocation points that reproduce pain levels. Imaging tests like x-rays or MRI may be ordered to rule out other conditions and evaluate bone alignment or extent of tendon/bursal changes.
Treatment Options for Impingement disorder
The main goals of any Impingement disorder treatment plan are to reduce inflammation and pressure in the shoulder joint, strengthen supporting muscles, correct mechanics issues, and allow healing of overstressed tissues. Approaches may include:
- Non-steroidal anti-inflammatory medications: Reduce pain and swelling.
- Corticosteroid injections: Decrease inflammation if it is significant contributor to symptoms.
- Manual therapy: Joint manipulation and soft tissue mobilization help restore mobility.
- Cryotherapy: Applying ice helps minimize discomfort.
- Postural education/ergonomic adjustments: Learning to avoid impingement positions at work or leisure.
- Range of motion exercises: Gentle stretching to regain lost shoulder mobility.
- Strengthening program: Focus on rotator cuff and scapular stabilizer muscles.
- Bracing/taping: Temporarily protect shoulder during healing phase.
- Surgery (for advanced cases): Decompression or repair procedures when conservative options fail.
- Lifestyle changes: Manage weight, quit smoking, modify aggravating recreational activities.
- Physical therapy: Comprehensive non-surgical rehabilitation regimens.
With a multifaceted treatment approach tailored to each individual case, full resolution of Impingement disorder symptoms is often achievable over a period of several months as inflammatory responses subside and mechanics improve. Recurrence is minimized by maintaining proactive posture and exercise habits once recovery is complete.
Impingement disorder causes significant shoulder pain and disability for many people. With an understanding of causes, risk factors, and implementing appropriate conservative treatment options, patients can make significant strides towards relieving symptoms of this overuse injury over time. Preventing repetitive traumas, keeping shoulders mobile, and monitoring for posture issues can also help lower risks long-term. Consultation with a physical therapist or orthopedist is advised if symptoms do not improve within 4-6 weeks of initial care.
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