Shoulder Impingement | Subacromial Impingement

What is shoulder impingement?

Shoulder impingement, also known as swimmer’s shoulder or impingement syndrome, is a common cause of shoulder pain. Shoulder impingement is caused by the compression of the rotator cuff tendons between the acromion (highest portion of the shoulder blade) and the humerus (upper arm). The result of this process is inflammation within the subacromial space, and subsequent thickening of the tendons and bursa (fluid-filled sacs). With the thickening of the rotator cuff tendons, a decrease in the amount of space available for tendon movement occurs, this lack of functional space results in the pinching of the rotator cuff tendons and bursae between the bones. Dr. Riley J. Williams, orthopedic shoulder specialist serving patients in Manhattan, Brooklyn, New York City, NY and surrounding areas, has the knowledge and understanding, as well as substantial experience in treating patients who have experienced shoulder impingement.

What is subacromial impingement?

Subacromial impingement is characterized by the irritation and inflammation of the tissue the sit just below the acromion process (top of the shoulder). The rotator cuff tendon and bursa exist in this space. When affected individuals raise their arm overhead, these structures are compressed between the upper arm and top of the shoulder blade.  The pain associated with subacromial impingement typically occurs with elevation of the arm above the head due to the narrowing of the subacromial space.

What causes shoulder impingement?

Shoulder impingement is commonly the result of repetitive overhead actions or chronic shoulder use. Inflammation of the bursa (bursitis) can occur from a number of injuries. The thickening of the tendons from continuous irritation can generate mechanical symptoms such as rubbing, grinding, or pinching. This is common among young athletes who perform repetitive overhead actions in sports like volleyball, baseball, tennis, and swimming. Individuals working in laborious type jobs (construction, building, painting), or someone who repetitively lifts overhead are also prone to shoulder impingement.

What are the symptoms of shoulder impingement?

The most common symptoms of shoulder impingement are:

• Sharp pain with activities involving reaching overhead or behind the back
• Radiating pain from the shoulder into the arm
• Shoulder weakness
• Worsening pain at night, particularly while sleeping on the affected side
• Aching pain noted at the upper arm

How is shoulder impingement diagnosed?

Prompt medical attention is recommended if shoulder impingement is suspected. Because the tissue will continue to thicken with repeated shoulder use, shoulder pain can worsen and damage to the rotator cuff can occur. If treated early, patients can minimize swelling and continued discomfort using conservative methods. Dr. Williams can diagnose shoulder impingement with a comprehensive medical history and physical examination. Diagnostic testing, including x-rays and magnetic resonance imaging (MRI), may be requested to identify any damage to any other structures within the shoulder.

What is the treatment for shoulder impingement?

Non-surgical treatment:

Patients who have been diagnosed with shoulder impingement are typically able to recover with conservative therapy. Activity modification, non-steroidal anti-inflammatory medications, and shoulder exercises can help patients reduce shoulder pain and inflammation associated with shoulder impingement. If the pain is not relieved by oral medications, a corticosteroid or platelet rich plasma (PRP) injection directly into the subacromial space can also be employed. When the pain and swelling have decreased, Dr. Williams will typically recommend a physical rehabilitation program aimed at strengthening the tendons and muscles of the rotator cuff and shoulder blade.

Surgical treatment:

If conservative methods are unsuccessful, Dr. Williams may recommend shoulder arthroscopy; this procedure is a minimally invasive surgery that uses a small camera to view the tendons and muscles of the shoulder. During this procedure, any irregularities, such as bone spurs or thickened bursa, are removed. Noted tears are repaired using specialized surgical instruments. A treatment called subacromial decompression will eliminate compression of the tendons between the humerus and the acromion. Dr. Williams does this procedure utilizing small incisions, thereby allowing patients to return to their normal activities in a shorter period of time.

For more information on shoulder impingement, subacromial impingement, or the excellent treatment options available, please contact the office of Dr. Riley J. Williams, orthopedic shoulder specialist serving Manhattan, Brooklyn, New York City, NY and surrounding areas.