Impingement Syndrome
Impingement syndrome is one of the most common causes of pain in the adult shoulder. Impingement can also be called painful arc syndrome, supraspinatus syndrome, swimmer's shoulder, and thrower's shoulder.
Clinical symptoms are caused by rotator cuff muscles becoming irritated and inflamed as they pass under the acromion of the scapulae. The rotator cuff consists of 4 muscles: supraspinatus, infraspinatus, subscapularis, and teres minor or (SITS muscles). These four muscles work together to lift and rotate the shoulder. They are attached on the front head (ball) of the humerus. The acromion of the scapulae sits over the front of the humeral head. When the arm is lifted with abnormal mechanics, pathology can occur.
Pathology can be: tendonitis; which is inflammation of the tendon; and /or bursitis, which is inflammation of the bursa. Both tendonitis and bursitis can be accompanied with pain, weakness and limited motion.
Pain is exacerbated with overhead or above the shoulder movement. Pain can cause disruption in sleep and an inability to sleep on the affected side. Onset of pain can be acute with trauma or gradual due to degenerative changes of the bone and/or tendon. Symptoms can be a popping or grinding sensation during movement.
Range of motion can be limited in an arc like pattern between 60 and 120 degrees of abduction. Advanced stages can turn into a frozen shoulder where all movements are limited and painful. Treatment needs to be directed at the condition, not just the symptoms.
Treatment can consist of:
Oral anti-inflammatories need to be initiated
Daily stretching
Modalities including heat and ice
Precautions:
Avoid excessive work above shoulder level, vacuuming, painting, raking leaves, and washing car
For persistent pain, a possible cortisone injection
Other treatments:
If pain persists and weakness is noted, a possible rotator cuff tear may be present. Further test and surgical intervention may be warranted.
September 2010 Featured Article
Impingement Syndrome
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