Impingement Syndrome

The rotator cuff is a name given to describe a series of individual muscles connecting the scapula (shoulder blade) to the humerus (upper arm). The rotator cuff plays an important role in maintaining the humeral head (ball of the ball and socket shoulder joint) within the glenoid (socket) during normal shoulder function. The rotator cuff also contributes to shoulder strength during activity. Normally, the rotator cuff glides smoothly between the undersurface of the acromion (roof of the shoulder joint) and the humeral head in the subacromial space.

Impingement refers to mechanical irritation of the rotator cuff tendons and/or structures in the subacromial space.

Any process which compromises the normal gliding function may lead to mechanical impingement. Common causes include weakening and degeneration of the tendons which occurs naturally with age. Formation of bone spurs and laxity of the glenohumeral joint also compromise the normal gliding function. This leads to inflammation and irritation within the subacromial space above the rotator cuff. Overuse activities can also lead to impingement and are most commonly seen in overhead racquet sports and swimming.

Diagnosis of shoulder impingement is made by taking a careful history and correlating it to the findings of a physical examination. Patients with impingement most commonly complain of discomfort locally in the shoulder, typically made worse with overhead activity. X-rays may be ordered by your doctor and are useful to establish the presence of bone spurs, evaluate narrowing of the subacromial space, and the general health of joint surfaces.

The first step in treating shoulder impingement is reducing the local tissue irritation. This may mean temporarily avoiding aggravating activities. A temporary course of anti-inflammatory medication can be very helpful in this regard. Identifying the underlying cause/s for the problem is crucial for effective treatment and to prevent recurrence. Your therapist will evaluate your problem and select certain manual mobilization techniques to restore normal flexibility and motion to the shoulder girdle.

Strengthening involves incorporating a specific strengthening regime for the rotator cuff complex and the muscles responsible for normal movement of the shoulder blade.

Treatment of your neck may also play a critical role in your recovery. The nerves controlling shoulder function originate here. Problems in this area predispose the shoulder to sprains and strains. Despite proper treatment local irritation can continue. In these situations your therapist or doctor may recommend an injection into your shoulder. Your therapist and doctor will work together to ensure proper care.