Shoulder Impingement

Shoulder pain is incredibly common and shoulder impingement ranks as one of the top causes of shoulder pain. Your shoulder is made up of several joints combined with tendons and muscles that allow incredible motion in your arm. These many different structures must work well together, and if they don’t, then shoulder pain may occur. The rotator cuff and the bursa directly above it are especially frequent sources of pain in the shoulder.

Shoulders can hurt because they are injured (rotator cuff tear, fracture, etc.), but they can also hurt because they are not functioning optimally. This phenomenon is referred to as “impingement syndrome.”

Shoulder impingement is a descriptive term referring to shoulder pain caused by mechanical irritation of one or more shoulder structures during shoulder motion. In impingement, the pain is not caused by an injury but rather by poor shoulder biomechanics that allows abnormal motion resulting in irritation and inflammation of the shoulder tissues.

Your shoulder is made up of three bones: your humerus (upper arm bone), your clavicle (collarbone), and your scapula (shoulder blade).

Your arm is kept in your shoulder socket by your rotator cuff. These muscles and tendons form a covering around the head of your humerus and attach it to your shoulder blade.

There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). The bursa allows the rotator cuff tendons to glide freely when you move your arm.

• Tendinitis. The rotator cuff tendons can be irritated or damaged (See Shoulder Tendinitis and Bursitis for more information).
• Bursitis. The bursa can become inflamed and swell with more fluid causing pain (See Shoulder Tendinitis and Bursitis for more information).
• Shoulder Impingement. When you raise your arm to shoulder height, the space between the acromion and rotator cuff narrows. The acromion can rub against (or "impinge" on) the tendon and the bursa, causing irritation and pain.

Shoulder impingement is often caused by:

• An irritated or swollen tendon due to repetitive activity of the shoulder, injury, or age-related wear and tear
• An irritated or inflamed bursa due to overuse of the shoulder or injury
• The development of age-related bone spurs on your acromion

While overhead athletes (swimmers, baseball players, tennis players) and people whose jobs require repetitive physical labor (construction workers, painters) are especially prone to developing shoulder impingement, shoulder impingement pain may occur without an apparent cause. Pain may also develop as the result of a minor injury to the shoulder.

If you have any of the following symptoms, call Dr. Jurek for a consultation:

• Pain when lifting your arm, lowering your arm from a raised position, or when reaching
• Pain when your arms are extended above your head
• Pain and tenderness in the front of your shoulder
• Pain that moves from the front of your shoulder to the side of your arm
• Pain when lying on the affected side
• Pain or achiness at night
• Pain when reaching behind your back
• Weakness and stiffness in the shoulder and/or arm

Medical History. Dr. Jurek will talk with you about your history and symptoms. She’ll also ask you questions about what may have caused your shoulder pain, when the pain began, what you have tried so far to relieve your pain, if you are involved in repetitive activities that require overhead arm movement, and if you have had any previous injuries to the affected arm/shoulder.

Physical Exam. Dr. Jurek will conduct a physical exam of your shoulder to identify the location of pain and tenderness and to assess your range of motion and arm/shoulder strength.

Imaging Studies. Dr. Jurek will check x-rays of your shoulder to look at the bony anatomy and rule out other possible causes of shoulder pain such as arthritis or calcification within the rotator cuff. She may also order magnetic resonance imaging (MRI) to identify possible injury to your rotator cuff or cartilage.

Although nonsurgical treatment may take several weeks to months, many patients experience a gradual improvement and return to function.

• Rest. Dr. Jurek may suggest relative rest as well as activity modification, such as avoiding repetitive overhead activities.
• Cold Therapy. Ice the shoulder for 20 minutes once or twice a day.
• NSAIDs. Over-the-counter anti-inflammatory medications, such as Ibuprofen or Naproxen, may help to reduce pain and swelling. These medications may have significant side effects so speak with your doctor before starting an NSAID.
• Physical Therapy. A physical therapist will initially focus on restoring normal motion to your shoulder. Stretching exercises to improve range of motion are very helpful. If you have difficulty reaching behind your back, you may have developed tightness of the posterior capsule of the shoulder (capsule refers to the inner lining of the shoulder and posterior refers to the back of the shoulder). Specific stretching of the posterior capsule can be very effective in relieving pain in the shoulder. Once your pain is improving, your therapist will start you on a strengthening program for the muscles of your shoulder.
• Cortisone Injection. If relative rest, medications, and physical therapy do not relieve your pain, an injection of a local anesthetic and a cortisone preparation may be helpful. Cortisone is a very effective anti-inflammatory medicine. Injecting it into the bursa beneath the acromion can relieve pain.

If you would like to discuss shoulder impingement treatment with Dr. Sara Jurek, call (206) 386-2600 to schedule a consultation. For your convenience, you may also request an appointment online.