Shoulder impingement syndrome

Shoulder | Orthopaedics | Shoulder impingement syndrome (Disease)


Impingement syndrome is a common condition affecting the shoulder and is 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 impingement syndrome is divided into 4 main types: Primary impingement ;Secondary impingement; Internal impingement; Subcoracoid impingement. It is important that the diagnosis is correctly made, because each type of impingement syndrome require treatment, rehabilitation program and / or surgery during the acute specific phase.

Causes and Risk factors

The rotator cuff muscle tendons pass through a narrow space between the acromion process of the scapula and the head of the humerus. Anything which causes further narrowing of this space can result in impingement syndrome. This can be caused by bony structures such as subacromial spurs (bony projections from the acromion), osteoarthritic spurs on the acromioclavicular joint, and variations in the shape of the acromion.

Thickening or calcification of the coracoacromial ligament can also cause impingement. Loss of function of the rotator cuff muscles, due to injury or loss of strength, may cause the humerus to move superiorly, resulting in impingement. Inflammation and subsequent thickening of the subacromial bursa may also cause impingement.

Diagnosis and Treatment

Clinical examination begins with inspection of the shoulder region in question, to detect any deformities, scars, swelling or loss of muscle mass (atrophy). Then, the shoulder joint and all muscle groups in the area are palpated to locate the pain. Passive and active ranges of motion will be determined by turning the patients arm in various planes and recording any decrease in movement and any pain that occurs in motion.

In impingement syndrome, conservative treatment involves resting the shoulder, local ice application ( 15 minutes 3-4 times per day) and administration of nonsteroidal anti-inflammatory drugs. The goal of treatment is to reduce pain and inflammation and restore normal function of the shoulder.

Surgical treatment is specific to each type of impingement and is invariably followed by physical therapy (analgesics and anti-inflammatory electrotherapy, magnetic therapy, laser therapy) and physical therapy to improve muscle strength and movement amplitude. ...

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