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Shoulder Impingement Syndrome
What Is Shoulder Impingement Syndrome?
Several forms of shoulder impingement syndrome have been described, however the classic and most common form will be reviewed here. This refers to a pinching or abrasion of the superior aspect (top) of the rotator cuff underneath the roof of the shoulder joint (the acromion process). The rotator cuff muscle and tendon pass through the shoulder between the humeral head (ball) and the acromion process (roof) of the scapula (shoulder blade). This narrow area can become a source of wear and tear on the rotator cuff for a variety of reasons.
If the rotator cuff itself is weak, then it will not function correctly to stabilize the ball and socket joint, allowing the ball (humeral head) to translate excessively with even normal arm motion. This motion brings the rotator cuff into closer proximity to the roof (acromion) and will lead to pinching and abrasion. This same problem can occur if the bone of the acromion is shaped abnormally or develops bone spurs. Both of these problems serve to further narrow this space and the rotator cuff is easily pinched and worn down. This can lead to tears in the rotator cuff (see rotator cuff tear) and bursitis.
This process causes pain and weakness due to irritation (and possibly tears) in the rotator cuff. Pain is most pronounced with overhead activity (reaching overhead, throwing motions, tennis serves, and reaching behind the back). It is also common to have pain with any lifting with the affected arm or with sleeping on the affected side.
The diagnosis of shoulder impingement syndrome is made by a combination of the history of the complaints and a few specialized physical exam tests. Occasionally, the physical exam tests will be augmented by testing before and after an injection of medication into this area. This injection serves to numb the area of pinching to verify that this is the source of pain, and that the rotator cuff is still functioning but its function is limited by pain and not limited by significant tears. This also helps demonstrate how treatment of the specific area may be beneficial.
Treatment for traditional shoulder impingement syndrome of the shoulder is with a dedicated physical therapy program to stabilize the shoulder muscles including the rotator cuff and the scapular stabilizing muscles (shoulder blade stabilizers). This is augmented with anti-inflammatory medications of either the oral (pill) form or injections, or even both. If this is not successful, then surgery may be indicated.
Surgery for traditional shoulder impingement syndrome is performed arthroscopically (see shoulder arthroscopy) and allows for a rapid recovery with minimal restrictions after surgery. The procedure may include the removal of the excess bone from the underside of the acromion as well as any scar tissue and bursitis in the shoulder. Occasionally, if a partial tear is found in the rotator cuff, this will be stimulated to heal as well. Physical therapy is still utilized after the surgery to provide a safe and rapid return to function, protecting the shoulder and strengthening it evenly.
Clinical Trials for Shoulder Impingement Syndrome
Clinical trials are research studies that evaluate a new medical approach, device, drug, or other treatment. As a Stanford Health Care patient, you may have access to the latest, advanced clinical trials.
Open trials refer to studies currently accepting participants. Closed trials are not currently enrolling, but may open in the future.
Shoulder Impingement Syndrome
Surgery for shoulder impingement syndrome is done arthroscopically and allows for rapid recovery with minimal restrictions. Learn more at Stanford Health Care.
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