UW Health's Sports Medicine doctors treat a wide range of common athletic injuries, including impingement syndrome, or a specific type of pain in the shoulder.
About Impingement Syndrome
Impingement syndrome is a name for many shoulder conditions, including rotator cuff tendonitis, bursitis or painful arc syndrome. With shoulder impingement, the rotator cuff tendons, the biceps tendon and subacromial bursa may be inflamed from repetitive microtrauma when the upper arm bone (humerus) and acromion (located on the shoulder blade or scapula) get “impinged” or pinched.
Impingement is a common overuse injury in sports such as baseball, softball, tennis, golf and swimming.
Signs and Symptoms
Shoulder impingement includes the following signs and symptoms:
- Pain in the front or on the top of the shoulder during and/or after overhead activity
- A painful arc of shoulder motion, which means that when raising the arm overhead only a portion of the movement is painful (instead of the entire movement)
- Shoulder weakness with overhead activity
- Night pain that may cause one to wake up while sleeping
In order to diagnose this condition, a medical provider performs a physical examination, which includes tests of movement and strength. In addition, x-rays may be needed to assess the alignment and cartilage spaces of the shoulder and to determine if any bone abnormalities exist. Further imaging, such as an MRI, may be done to assess many soft tissue structures, including tendons, ligaments and the joint capsule, especially if initial treatment does not improve the patient’s symptoms.
Shoulder impingement may occur with:
- Chronic, repetitive overhead activities, which may occur with specific sports or jobs
- Sudden increases or changes in overhead activities
- Limitation of shoulder motion, especially with tight shoulder muscles or joint capsule
- Fatigue of shoulder muscles during prolonged overhead activities
- Acute trauma to the shoulder area that results in inflammation
Rehabilitation often takes place, and includes:
- Decreasing, modifying or stopping overhead activities
- Stretching and warming up prior to activity
- Icing after activity for 15 to 20 minutes
- Using joint mobilizations to improve joint flexibility and mechanics
- Exercising to optimize posture, flexibility, strength and movement patterns to decrease the risk of impingement
- Progressing the overall treatment plan for return to sport/work activities
- Anti-inflammatory medication as prescribed by a physician
- A cortisone injection into the area of inflammation may be considered
If conservative treatment is not successful in improving symptoms, surgical intervention may be discussed. A shoulder arthroscopy can address the various causes of shoulder impingement and the procedure may include:
- A subacromial decompression, in which the acromion is shaved down to make room for the rotator cuff
- A biceps tenotomy or biceps tenodesis, in which the biceps tendon is either cut (tenotomy) or cut and reattached to the upper part of the humerus (tenodesis)
- A debridement, or removal, of any inflamed tissue that may be causing pain