Shoulder Impingement

Impingement is common in both young and middle-aged athletes. Young athletes who use their arms overhead for swimming, baseball, or tennis are particularly vulnerable. Those who do repetitive lifting or overhead activities using their arms also are susceptible. Pain may develop as the result of minor trauma or spontaneously, with no apparent cause. 

Shoulder impingement results from pressure on the rotator cuff from part of the shoulder blade (scapula) as the arm is lifted. The acromion (the top of the scapula) rubs, or "impinges" on, the surface of the rotator cuff. This causes pain and limits movement.

Beginning symptoms may be mild. Patients frequently do not seek treatment at an early stage.

Symptoms may 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
• Pain when throwing or lifting weights for athletes in overhead sports

As the problem progresses, there may be pain at night. Strength and motion may be lost. It may be difficult to perform activities that place the arm behind the back.

Treatment

Initial treatment is nonsurgical and may include rest and avoiding overhead activities. Use of oral, nonsteroidal anti-inflammatory medication may be prescribed. Stretching exercises to improve range of motion in a stiff shoulder also will help. Many patients benefit from injection of a local anesthetic and a cortisone preparation to the affected area. Treatment may take several weeks to months. Many patients experience a gradual improvement and return to function.

Surgical treatment may be required when nonsurgical treatment does not relieve pain. The goal of surgery is to remove the impingement and create more space for the rotator cuff. This allows the humeral head to move freely in the subacromial space and the arm to be lifted without pain.

After surgery, the arm may be placed in a sling for a short period of time. As soon as comfort allows, the sling may be removed to begin exercise and use of the arm. It typically takes two to four months to achieve complete relief of pain, and may take up to a year.

Most shoulder injuries can be prevented by using correct technique, along with a stretching and strengthening program.