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Shoulder Impingement

Shoulder impingement happens when bone rubs against tissue in the your shoulder joint, causing pain. It's common in athletes and people who do repetitive, overhead movements for work.

Most cases dramatically improve with rest, shoulder impingement exercises, and medicine.

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What Is Shoulder Impingement? 

Shoulder impingement is when the shoulder blade gets too close to tissue in the rotator cuff — the group of tendons and muscles surrounding the shoulder joint. When this happens, it causes irritation, swelling, and pain.

Shoulder impingement makes it difficult to throw, or move your arm above or behind you. Impingement syndrome requires rest, physical therapy, and in some cases, surgery. Without treatment, the problem will likely get worse over time.

How common is shoulder impingement?

Shoulder impingement is responsible for up to 65% of all doctors' visits for shoulder pain, according to the National Library of Medicine.

What causes shoulder impingement? 

Shoulder impingement usually happens when the tendons or fluid-filled sacs (bursa) in the rotator cuff become swollen from overuse. Because there's little space in the shoulder, the swollen tissue hits against the shoulder bone. This leads to pain and further swelling.

In some cases, a bone spur grows on the shoulder bone which irritates tissue in the joint.

What are shoulder impingement risk factors and complications?

Shoulder impingement is more common in athletes and people who use their shoulder muscles at work.

Shoulder impingement risk factors 

People are more likely to get shoulder impingement if they:

  • Are older. While shoulder impingement can happen to young athletes, people in their 60s are at the highest risk.
  • Play golf, racquet sports, volleyball, or baseball, or engage in other sports that strain the rotator cuff.
  • Lift or push items above their head for work. (Carpenters and painters are at a higher risk of getting shoulder impingement.)
  • Smoke cigarettes. Smoking can make tissues in the body more prone to damage and swelling.

Complications of shoulder impingement

If not addressed, shoulder impingement can cause bigger problems, including:

  • A tear in the biceps tendon.
  • A tear in the rotator cuff.
  • Frozen shoulder.

How can I prevent shoulder impingement?

Follow these tips to avoid shoulder impingement:

  • If you experience pain in the shoulder, take a break from whatever movements increase pain.
  • Sit with your shoulders back. Hunching or slouching limits the space for your rotator cuff.
  • Stretch your shoulder muscles often.
  • Strengthen all of your shoulder muscles to reduce the strain on one part. A personal trainer or physical therapist can help.

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What Are the Signs and Symptoms of Shoulder Impingement?

Symptoms of shoulder impingement tend to come on slowly and get worse over time. The main symptom is pain, especially:

  • At night, especially when you lie in a way that puts pressure on the shoulder.
  • When you raise your arm over your head or reach behind you.
  • When lifting weights.

You also may have stiffness or weakness in your shoulder.

When should I see a doctor about my shoulder impingement symptoms?

Seek treatment when you notice shoulder impingement symptoms, so you can prevent your shoulder problem from getting worse.

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How Do You Diagnose Shoulder Impingement?

Your doctor will diagnose shoulder impingement based on your symptoms. They may also order an imaging test.

What to expect during your visit

Your doctor will ask you questions about your lifestyle and pain, including:

  • Did your pain come on gradually or suddenly?
  • What do you do for leisure or work that involves the shoulder?
  • What movements make your pain worse?
  • When did your pain start?

Your doctor will have you move your arm and shoulder in various ways. They'll also gently move your arm to assess what types of movements cause pain.

Tests to diagnose shoulder impingement

Your doctor will order an imaging test if they're not sure of the diagnosis or if your symptoms aren't improving with therapy. Imaging options include:

MRIs and ultrasounds can show damage or swelling to the soft tissues, including the tendons.

An x-ray may show bone spurs, which can cause impingement syndrome. An x-ray also may show a smaller space between the shoulder bones, which suggests arthritis.

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How Do You Treat Shoulder Impingement? 

The main shoulder impingement treatments are rest and physical therapy, along with medicine to help relieve pain. Rarely does shoulder impingement require surgery.

Activity restriction (rest)

Your doctor will tell you what movements to avoid, and for how long. If you have shoulder impingement, you should avoid throwing, lifting anything above your head, or swinging your arms high.

Physical therapy for shoulder impingement

As your shoulder impingement heals, your physical therapist or orthopaedic doctor will introduce shoulder impingement exercises. By strengthening weaker muscles, you can relieve overused muscles. You'll also learn stretching exercises to increase the range of motion in the shoulder.

Medications for shoulder impingement

Oral nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, can relieve shoulder impingement pain. Talk to your doctor about how long you should take these medicines and at what dose.

Your doctor also may suggest steroid injections into the shoulder joint to relieve swelling and pain as you recover.

Surgery for shoulder impingement

Surgery is a rare treatment option for shoulder impingement. Doctors only pursue surgery when other treatments don't work.

The surgeon may need to remove a small piece of bone that is irritating the shoulder tissue. Or, they may remove or repair damaged tissue in the shoulder joint. For example, a surgeon can repair a tendon by removing the damaged part and reattaching the ends of the tendon.

You will need to wear a sling after surgery for at least a week.

How effective is treatment?

Up to 90% of people with shoulder impingement improve with nonsurgical treatments. Once your doctor gives you a treatment plan, follow up with them if symptoms don't improve within 8 to 12 weeks. It can take 3 to 6 months for pain to fully resolve.

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