SHOULDER

Shoulder Impingement

The shoulder is complex and made up of several joints combined with tendons and muscles that allow a great range of motion in your arm. Many different structures make up the shoulder allowing it to offer a wide range of motion however it is vulnerable to many different problems.

The shoulder is made up of three bones, upper arm bone (humerus), shoulder blade (scapula) and collarbone (clavicle). There are two joints in the shoulder:

  • Acromioclavicular (AC) joint - where the clavicle and top of the shoulder blade (acromion)
  • Glenohumeral joint - where the head of the humerus fits into the scapular

A combination of muscles and tendons keeps your humerus centred in its shoulder socket and helps control, stabilise and function the shoulder. These are called the rotator cuff. 


Shoulder Impingement occurs when there is an impingement of tendons or bursa from bones of the shoulder. Over time this can lead to inflammation of the rotator cuff tendons and bursa.



Symptoms

Pain is the main symptom experienced from Shoulder Impingement. Beginning symptoms may be mild including:

  • Minor pain present both with activity and rest
  • Pain radiating from the front of the shoulder to the side of the arm
  • Sudden pain with lifting and reaching movements

As the pain progresses symptoms increase to:

  • Pain at night
  • Loss of strength and motion
  • Difficulty doing activities that place the arm behind the back such as buttoning or zipping clothes. 



Causes

Shoulder impingement is common in young athletes and middle-aged people. Young athletes who use their arms overhead for sports including swimming, baseball and tennis are particularly vulnerable. Repetitive lifting or overhead activities may also be another cause. Pain may also develop as a result of minor injury.



Diagnosis

Diagnosis is made by medical consultation and examination, taking the patient's past medical history. Dr du Sart will check to see whether your shoulder is tender in any area or there is deformity. Range of motion and arm strength is also tested. X-ray may be ordered to show bone spurs or rule out other diagnoses like arthritis however will not show soft tissue for example rotator cuff. MRI can create better images of soft tissues like rotator cuff tendons and show fluid or inflammation in the bursa.



Treatment Options

Non Operative Treatment

In most cases, initial treatment is non operative and may take several weeks to months for patients to return to function. It is important to rest your shoulder as able and modify activities to avoid overhead activities.  Pain killers (paracetamol or panadol osteo) and anti-inflammatories if tolerated and not contraindicated may also be recommended. Physical therapy including stretching exercises to improve range of motion are helpful and can help relieve pain. Corticosteroid injections may also help relieve pain


Surgery

When non operative treatment has been ineffective, surgery may be recommended.


Shoulder Arthroscopy is minimally invasive and helps diagnose and/or treat the injury. The goal of surgery for shoulder impingement is to create more space for the rotator cuff. To do this, the inflamed portion of the bursa is removed, along with part of the acromion if required. 


Find out more about Shoulder Arthroscopy.

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