SHOULDER IMPINGEMENT

Shoulder impingement

Shoulder impingement, also called "impingement syndrome", is a common cause of shoulder pain and restricted movement. It occurs when the tendons of the rotator cuff are compressed or irritated within the shoulder joint, which leads to pain, inflammation and reduced movement. With movements above the head in particular, this can cause considerable trouble. In many cases early diagnosis and treatment relieve the symptoms effectively and prevent them from getting worse.

What is shoulder impingement?

The shoulder joint

The shoulder is the most mobile joint in the human body and allows a wide range of arm movements. It consists of the upper arm bone (the humerus), the socket of the shoulder (the glenoid) and various tendons and muscles known as the rotator cuff. These muscles and tendons stabilise the joint and allow it to move smoothly.

How impingement arises

Shoulder impingement arises when the tendons of the rotator cuff (the supraspinatus tendon in particular) are compressed by the bones of the shoulder. This tightness causes friction and can lead to inflammation of the tendons (tendinitis) or of the bursa (bursitis). Over a longer period it can damage the tendons and restrict the movement of the shoulder.

Causes of shoulder impingement

The causes of shoulder impingement are varied and can come both from outside loading and from natural changes within the shoulder joint.

Overloading and repeated movement: frequent, repeated movements of the arm above the head – in sport (tennis or swimming, for instance) or in certain occupations – can compress the tendons mechanically.
Changes in the shoulder joint: acute trauma such as a fall or a direct force on the shoulder can immediately narrow the space or damage the tendons.
Injuries: congenital or acquired deformities of the shoulder, such as a dislocation or dysplasia (a malformation of the joint), can raise the risk of impingement, because they distribute the load on the joint unevenly.
Anatomical causes: some people are at higher risk of developing impingement because of their natural shoulder anatomy. A narrow space between the socket and the head of the upper arm, or tendons that are not well aligned, can encourage it.

Symptoms

The symptoms of shoulder impingement usually develop slowly and depend above all on how often and in what way the shoulder is loaded, and on how far the tendons are compressed. Typically the trouble shows itself as pain, particularly with certain movements of the arm, as restricted movement of the shoulder joint and as increasing stiffness.

Pain

Stabbing or burning pain occurs particularly with movements above the head or when lifting the arm.

Restricted movement

Over time the movement of the shoulder decreases, which makes lifting the arm or turning the wrist harder.

Pain at night

Many patients report pain at night, which gets worse in particular when lying on the affected shoulder.

Diagnosis

The diagnosis of shoulder impingement follows from the account of the symptoms and from a targeted physical examination. Imaging then shows what is causing the tightness and whether the tendons have already been damaged.

Clinical examination

The doctor will first test the movement and the stability of the shoulder joint. Specific tests are carried out in which the shoulder is moved into various positions, in order to reproduce the symptoms and confirm the impingement.

X-ray

X-rays can help to identify bone spurs or changes in the structure of the joint that could be causing the tightness

MRI (magnetic resonance imaging)

An MRI gives detailed information about the state of the tendons, muscles and soft tissue. It can show inflammation, damage to the tendons or damage to the bursa.

Ultrasound

In some cases an ultrasound can also be helpful, to look at the tendons and the tissue around the joint.

Treatment options

Treatment of shoulder impingement aims to relieve the pain, reduce the inflammation and restore the movement of the shoulder joint. In most cases it begins with conservative measures directed at relieving the symptoms and improving the function of the shoulder.

Where conservative treatment is not enough, surgical options can be considered, in order to remove the mechanical tightness around the tendons and stabilise the function of the shoulder joint.

Treatment options

Non-surgical and surgical – we will find the right approach for you

Non-surgical

Drug treatment

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, diclofenac or naproxen are frequently used to relieve pain and reduce inflammation.

Non-surgical

Physiotherapy

Targeted physiotherapy is an important part of treatment. Specific exercises are used to stretch and strengthen the muscles of the shoulder and neck. This improves movement and reduces the load on the tendons.

Surgical

Arthroscopic decompression

Arthroscopic decompression for shoulder impingement is a minimally invasive procedure in which bone spurs and other structural changes in the subacromial space are removed, in order to reduce the pressure on the tendons of the rotator cuff.

Frequently asked questions about shoulder impingement

Here you will find answers to the most common questions about shoulder impingement and its treatment.

What is shoulder impingement?

Shoulder impingement occurs when the tendons of the rotator cuff are compressed by bony structures within the shoulder joint, which leads to inflammation, pain and restricted movement. Symptoms occur particularly with movements above the head or when lifting loads.

What causes shoulder impingement?

The main causes are repeated, excessive movements of the arm above the head (in sport or in certain occupations, for instance), structural changes such as bone spurs, trauma, or anatomical features of the shoulder that can narrow the space available to the tendons.

Which symptoms point to shoulder impingement?

Typical symptoms are pain around the shoulder, particularly with movements of the arm above the head or when the shoulder is loaded, restricted movement, stiffness, and pain radiating into the upper arm or the neck. Pain at night is also common, especially when lying on the affected side.

How is shoulder impingement diagnosed?

Shoulder impingement is usually diagnosed through a thorough clinical examination, in which the doctor tests particular movements of the arm in order to bring on the pain. Imaging such as X-rays and magnetic resonance imaging (MRI) can be used to make structural changes such as bone spurs or tendon damage visible.

How is shoulder impingement treated?

In most cases treatment begins with conservative measures such as physiotherapy, painkillers and anti-inflammatory medication. With severe pain or progressive impingement a corticosteroid injection can help. Where these measures are not enough, surgical treatment such as arthroscopic decompression may be necessary.

What is arthroscopic decompression?

Arthroscopic decompression is a minimally invasive procedure in which the subacromial space is widened by removing bone spurs and repairing inflamed tissue. This method helps to reduce the pressure on the tendons and to restore the movement of the shoulder.

When is an operation necessary?

An operation is considered when conservative treatment does not bring sufficient relief or the impingement progresses. This is frequently the case with structural changes such as bone spurs or considerable tendon damage that are causing the impingement.

Can I do sport again after treatment?

As a rule patients can take up their sporting activities again after successful treatment of shoulder impingement, particularly after an operation and rehabilitation. The return to sport should be step by step, however, and demanding sports should be avoided in the first months after treatment.

What can I do to avoid shoulder impingement?

Prevention includes avoiding overloading and repeated movements above the head, particularly in sport or in certain occupations. Regular strengthening of the shoulder and neck muscles and stretching exercises can help to reduce the risk of impingement. At the first signs of trouble, a doctor should be consulted early.

Our shoulder specialist

Experienced specialists for shoulder impingement and shoulder surgery

Dr. med. Ralph Mayer

Consultant in Orthopaedics, specialist orthopaedic surgery