Shoulder Impingement Syndrome

Shoulder impingement syndrome is a common cause of shoulder pain. It occurs when there is impingement of tendons or bursa in the shoulder from bones of the shoulder. Overhead activity of the shoulder, especially repeated activity, is a risk factor for shoulder impingement syndrome. Examples include: painting, lifting, swimming, tennis, and other overhead sports. Other risk factors include bone and joint abnormalities.

With impingement syndrome, pain is persistent and affects everyday activities. Motions such as reaching up behind the back or reaching up overhead to put on a coat or blouse, for example, may cause pain.

Over time, impingement syndrome can lead to inflammation of the rotator cuff tendons (tendinitis) and bursa (bursitis). If not treated appropriately, the rotator cuff tendons can start to thin and tear.

What Are the Symptoms of Shoulder Impingement Syndrome?
The typical symptoms of impingement syndrome include difficulty reaching up behind the back, pain with overhead use of the arm and weakness of shoulder muscles.

If tendons are injured for a long period of time, the tendon can actually tear in two, resulting in a rotator cuff tear. This causes significant weakness and may make it difficult for the person to elevate his or her arm. Some people can have rupture of their biceps muscle as part of this continuing impingement process.

How Is Impingement Syndrome Diagnosed?
Diagnosis of impingement syndrome begins with a medical history and physical exam by your doctor. X-rays will be taken to rule out arthritis and may show changes in the bone that indicate injury of the muscle. Bone spurs or changes in the normal contour of the bone may be present.

How Is Shoulder Impingement Syndrome Usually Treated?
Oral anti-inflammatory medications — such as aspirin, naproxen, or ibuprofen, remain the most common treatment for impingement syndrome.

The medicines are usually given for six to eight weeks since it often takes that long to fully treat the problem. You should do this under the care of a doctor because these medications can cause stomach irritation and bleeding.

In addition to taking medications, daily stretching in a warm shower will help. You should work to reach your thumb up and behind your back. Avoid repetitive activities with your injured arm, particularly activities where the elbow would move above shoulder level. Your doctor may refer you to a physical therapist who can demonstrate the exercises most effective in strengthening and stretching the shoulder muscles.

If you have persistent symptoms, despite the use of oral anti-inflammatory drugs, your doctor may consider a cortisone-type injection. Cortisone is a potent anti-inflammatory medication, which should be used only when necessary because it can result in weakening of muscles and tendons if used repeatedly.

If symptoms persist or if significant weakness is present, then your doctor may perform an ultrasound, MRI, or arthrogram to rule out a rotator cuff tear. If the cuff is torn, surgery may be necessary to repair it.

The vast majority of people who have impingement syndrome are successfully treated with medication, stretching exercises, and temporary avoidance of repetitive overhead activity until the condition settles down.

What Are the Side Effects of Impingement Syndrome Treatment with using medication?
Upset stomach, indigestion, and headaches are the most common side effects of oral anti-inflammatory drugs. However, taking these medications after meals or with food can help reduce stomach upset. Anti-inflammatory drugs can also cause vomiting, constipation, and bleeding in the stomach (ulcers), although these side effects are not common.

Side effects of cortisone shots depend on the dose and frequency of the injections. Unlike cortisone pills, occasional cortisone injections rarely cause serious side effects. Side effects that are much more common with cortisone pills include elevated blood sugar, a decrease in the body’s resistance to infection, weight gain, osteoporosis (thinning of the bones), thinning of the skin, cataracts, and raised blood pressure.