Subarcromial/Shoulder impingement syndrome - symptoms | diagnosis | treatment

Subacromial/Shoulder impingement syndrome - symptoms | diagnosis | treatment

overview

subacromial/shoulder impingement syndrome also known as the swimmer's shoulder is an inflammation of the muscles in the shoulder area. The condition is commonly seen in active people and risk increases with age. It is one of the most commonly seen conditions in outpatient clinics and is related to muscle strength imbalances, rotator cuff tear, and poor scapula control.

Pain, instability, and weakness with loss of range of motion are common presenting complaints. With any shoulder problem, it is important to inquire about the patient's occupation, recreational activities, and hand dominance as it helps to understand how it affected the quality of life of a patient. For eg., an athlete can complain of pain with mild impingement while an elderly even with full-thickness rotator cuff tear can have no symptoms.

shoulder impingement syndrome is one of the most common causes of shoulder pain. Repeated overhead activities like swimming, tennis, and lifting are the main risk factors for shoulder impingement syndrome. Some other less common risk factors include bone and joint abnormalities.
If left untreated with time shoulder impingement can cause inflammation of the rotator cuff tendons causing thinning of tendons and eventually tear.

What are the symptoms of shoulder impingement syndrome :

the classical symptoms of the shoulder impingement syndrome are -

1) Pain with overhead activities (tennis, swimming)

2) Pain at night while sleeping on the shoulder

3) Pain with the internal rotation of the shoulder (eg. puttings jacket or bra)

4) Shoulder weakness

5) loss of range of motion of the shoulder

In some cases of shoulder impingement syndrome tendon can year partially or completely resulting in rotator cuff tear as a result of the long-standing injury. This leads to significant weakness and loss of the active range of motion.
Patients with impingement syndrome can have mild winging of the scapula and in some cases rupture of the biceps tendon can also be seen as a result of the continuing impingement process.
after careful examination tenderness over the greater tuberosity of the humerus bone can be elicited. Patients may lack the full active range of motion but should have a preserved passive range of motion.

How shoulder impingement syndrome is diagnosed?

shoulder impingement syndrome can be diagnosed by the patient's history and physical examination by the doctor. tenderness over the greater tuberosity of the humerus is the classical sign on physical examination.
X-rays are usually advised to rule out arthritis and may show rotator cuff injury. Bone spurs or changes in the normal contour of the bone are present.MRI of the shoulder may demonstrate partial or full-thickness tear and superior to USG in identifying partial tear from the full thickness tear.

How shoulder impingement syndrome is treated

The first line of treatment of shoulder impingement syndrome is usually a conservative approach with education, physical therapy, and activity modification. Proper counseling with activity modification can prevent a person from worsening his/her condition. Activity modification includes avoidance of repeated overhead activities. Shoulder impingement syndrome is caused by muscle weakness and tear hence, strengthening of rotator cuff muscles can alleviate pain and weakness unless the tendons are seriously compromised.
Physical therapy is directed at rotator cuff muscle strengthening, scapular stabilization, and postural exercises.

In addition to this oral antiinflammatory drugs such as aspirin, naproxen or ibuprofen are used to reduce the pain. These are usually given for six to eight weeks. However, there is no preferred anti-inflammatory medication to the condition as the response to a given medication differs from person to person. If an anti-inflammatory medication does not help within two weeks then another one is given until the one that provides relief is found.
These medications should be taken under the supervision of the doctor as they can cause stomach irritation, vomiting, and headache.

If the symptoms persist despite the use of oral medication, cortisone injections are advised to alleviate the pain and weakness. Cortisone is a potent anti-inflammatory agent that should be used only in severe cases because it can cause the weakening of the muscles and tendons on repeated use. Cortisone injections rarely cause any serious side effects with normal doses but as the frequency increases can cause elevated blood sugar, elevated blood pressure, weight gain, decreased immunity, osteoporosis, and cataracts.

If the symptoms persist despite the use of the cortisone injections then your doctor may advise an MRI, arthrogram, or ultrasound to rule out the rotator cuff tear, and if present surgery may be necessary to repair it.
However, most people who have shoulder impingement syndrome are treated successfully with medication and physical therapy, and stretching exercises.