Impingement

Overview

Impingement is one of the most common causes of pain in adult shoulders and is caused by pressure being placed on the rotator cuff from part of the shoulder blade as the arm is lifted.

As the arm is lifted, the acromion, which is the front edge of the shoulder blade, rubs or "impinges" on the surface of the rotator cuff. The cuff is a tendon that links the four muscles that cover the ball end of the humerus, which fits into the socket in the shoulder. The impingement causes pain and limits movement.

What Causes Impingement?

Impingement is common in young athletes and middle-aged people. In young athletes the cause is the repetitive motion of overhead sports activities, such as weightlifting, pitching or gymnastics. Those who do repetitive lifting or engage in any activities that requires a lot of overhead motion using the arms are also susceptible. Pain can either appear as the result of an immediate minor trauma or for no apparent reason at all.

Symptoms

Initially, the symptoms of impingement can be mild. Patients usually don't seek treatment in the early stages.

Symptoms can include:

• Minor pain that is present both with activity and at rest.
• Pain radiating from the front of the shoulder to the side of the arm.
• Sudden pain with lifting and reaching movements.
• Athletes in overhead sports may have pain when throwing or serving a tennis ball.

Impingement usually causes local swelling and tenderness in the front part of the shoulder. There also may be some pain and stiffness when the arm is lifted or lowered from an elevated position. As the impingement continues to get worse, you may experience pain at night and strength and motion may be lost. Participating in activities where the arm is placed behind the back may be difficult.

Treatment

Treatment at the FHCH Sports Medicine Program begins with a review of the symptoms and an examination of the shoulder by one of our orthopaedic surgeons. The doctor may request additional imaging studies, such as an MRI. These studies will be able to show fluid or inflammation in the bursa and rotator cuff. In some cases, partial tearing of the rotator cuff may also be evident. An impingement test, which involves injecting a local anesthetic into the bursa, can help confirm the diagnosis.

Non-surgical options are used in the initial phase of treatment. Your orthopaedic surgeon may suggest that you rest and avoid any overhead activities. An oral non-steroidal anti-inflammatory medication may also be prescribed. Many patients also benefit from an injection of a local anesthetic and a cortisone preparation to the area that has been affected.

Stretching exercises can improve the range of motion in a stiff shoulder. Your doctor may also recommend participation in a program of supervised physical therapy. Treatment for impingement can take several weeks to months. Many patients report a gradual improvement in motion and function.

For surgical options, click here.

If you have questions about impingement or want to make an appointment, please contact one of our Patient Care Coordinators and they'll be happy to assist you.