What is shoulder impingement syndrome?

The rotator cuff muscles which help support the shoulder pass through a narrow space inside the shoulder. Anything which causes further narrowing of this space can result in the rotator cuff tendons and other shoulder tissue to be pinched when the arm is raised upwards or away from the body.

With repetitive impingement, the tendons and bursa can become inflamed, swollen, or degenerative, causing rotator cuff tendinopathy.

In young, athletic individuals, injury to the rotator cuff can occur with repetitive throwing, overhead racquet sports, or swimming which involve repetitive use of the rotator cuff muscles, also called swimmer’s or thrower’s shoulder.

How does it feel?

The most common complaint is aching located in the top and front of the shoulder, or on the outer side of the upper arm. The pain is usually increased when the arm is lifted overhead. The pain may be worse at night especially if you lie on the affected shoulder and may interrupt sleep. Depending on the severity of the injury, there may be weakness in the arm or restricted range of shoulder movements such that the arm cannot be lifted fully.

What can I do?

Avoid repetitive overhead activities that may aggravate the pain. Application of ice to the tender area three or four times a day for 15 minutes at a time may be helpful. Seek early medical consultation as the diagnosis of rotator cuff tendon disease requires a careful history-taking process and thorough clinical examination by the physician.

Can it be prevented?

Attention must be paid to flexibility, strength and endurance of the shoulder muscles, ensuring that the muscles of the shoulder blade in the upper back (the scapula) are strengthened.

For athletes in sports involving repetitive overheard arm movements, learning the correct technique and choosing proper equipment are also important. In addition, any increase in the amount of training or competition must be gradual so as not to overload the shoulders. A proper warm up and cool down may also help to prevent injuries in general.

What can we do to help you?

In order to determine the cause of your symptoms, your doctor will ask you a series of questions and conduct a physical examination which includes special physical exam tests for the shoulder. X-ray is useful to visualise the shoulder bones. Your doctor might also recommend diagnostic tests such as an ultrasound scan or an MRI (magnetic resonance imaging) scan. Imaging is not required in all cases of shoulder pain. If your symptoms are mild, your doctor may recommend a period of rest coupled with pain medications. Activities causing the pain should be resumed gradually when the pain is gone.

You will also be scheduled for physiotherapy as part of an early rehabilitation process.

Sometimes a corticosteroid injection into the shoulder joint can help temporarily relieve pain.

Physiotherapy is often effective in treating shoulder impingement and rotator cuff disorders. The first aim of treatment is to reduce any swelling or inflammation using ice and an anti-inflammatory medication prescribed by your doctor. Then, exercises can begin, followed by a shoulder strengthening programme. Sporting technique errors that may have caused the problem in the first place will also be addressed.

What does surgery involve?

If you have been diagnosed with a complete tear, your doctor might recommend surgery. The choice of surgery depends on the severity of the pain, your general health, and the functional requirements for that shoulder. In young athletic individuals, repair of the tendon is most often suggested. In some older individuals who do not need to lift much overhead, surgical repair may not always be necessary.