Impingement Syndrome

What is it?
Subacromial impingement syndrome is a common condition in the shoulder that is also known as rotator cuff tendonitis or subacromial bursitis. It occurs when the tissues surrounding the rotator cuff become inflamed, often from mechanical irritation. There is a spectrum of conditions ranging from simple bursitis (irritation of these tissues) to painful tears and degeneration in the rotator cuff tendons themselves. The rotator cuff muscles are small but powerful muscles that lie deep inside your shoulder and function to keep the shoulder stable and move your upper arm. The symptoms most people experience typically include nagging and hard to localize pain in the shoulder that can radiate down the side of the upper arm or into the neck. People often experience pain when the arm is over head, such as when reaching for an object in the top of the cupboard. Many people have pain that is worse at night, often waking them from sleep or preventing restful sleep altogether. Weakness is generally associated with large rotator cuff tears and not usually with simple impingement.

What causes it?
There are many causes of subacromial impingement. Most often, repetitive overhead motion such as swimming or throwing can cause it. It may occur from an injury (even a very minor injury) that can cause the rotator cuff muscles to work inefficiently, leading to altered shoulder mechanics and “secondary impingement”. Occasionally, there is no obvious identifiable cause, and it is attributed to “wear and tear” in these circumstances.

What is the conservative (first line) treatment?
The primary treatment is exercise therapy, either with a therapist or on your own. The rotator cuff muscles need to be strengthened so that they may work more efficiently and help stabilize your shoulder. A helpful video demonstrating some of the exercises is available for viewing in the 'patient education' portion of our website. These exercises can be very successful in treating this condition. It may take up to 3 months or longer to fully benefit from therapy, so stay with it as long as you can – it is worth it. Sometimes your inflammation can be so severe that an injection is done in addition to therapy. The injection is a combination of a short-acting analgesic and a corticosteroid which helps control the inflammation. The injection may make your shoulder sore for a few days, but once the steroid starts to work (one week approximately) you should feel better. You may need several injections over a few months to calm down the inflammation.

What if that fails to relieve my condition?
If you have done physical therapy and have tried injections with no benefit, the next step is to consider surgery. Surgery is done either arthroscopically (through 2 or 3 small incisions) or open (with one small incision) or with a combination of the two. There are no differences in long-term outcome between the two techniques. The surgery removes the irritated tissues and removes any bone spurs that may be exacerbating the irritation. The surgery takes about an hour and you typically go home the same day. The recovery can be quite fast, but certainly some people recover more quickly than others. Most people have a sling for a week or two for comfort, and there is usually no limit to what you are allowed to do with your shoulder after the surgery. It may take some work with the physical therapists to regain all of your motion but this is usually achieved by 6 weeks after surgery.

How successful is surgery for this?
The surgery is generally very successful. Approximately 90% of people get significantly better after the surgery. The pain you feel at night is usually gone, and overhead activities become much more tolerable. Shoulder stiffness is a problem that is associated with this treatment, and it is for the most part preventable with physical therapy.

What can I do to prevent this from happening again?
The best method of protection is to avoid exacerbating conditions such as repetitive overhead activities, and to keep your shoulder strong. If you feel the pain coming back, start with the physical therapy exercises early.