(317) 920-7432 | Online Registration

What Is Impingement Syndrome?

If you've noticed shoulder pain when raising your arm, you may have impingement syndrome. This is pinching within your shoulder. The problem may have been caused by repeating an overhead motion.

What Are the Symptoms?

Pain, pinching, and stiffness in your shoulder when raising your arm are common symptoms of impingement. In some cases, you may feel a nagging pain even when you're not using your shoulder.

Who Gets Impingement?

People with impingement are often young women and men who make repeated overhead movements. These movements can cause a repetitive motion injury (RMI). An RMI may occur when a forceful action is repeated day after day without resting. Some activities that may lead to RMIs include:

  • Warehousing or shipping
  • Painting or carpentry
  • Swimming, tennis, softball, and other sports
  • Weekend home repair

Impingement also may occur if one of your shoulder bones is shaped a certain way. In some cases, older people may get impingement after years of normal shoulder use.

How Is Impingement Diagnosed?

Your doctor will carefully examine your shoulder. He or she also may do some of the following tests:

  • Impingement Sign Test. You slowly raise your arms as your doctor guides them. Point out to your doctor when you begin to feel pain. 
  • Strength Test. With your arms raised, your doctor gently presses down on them while you try to resist.
  • X-rays. X-ray images of your shoulder can show whether bone shape is causing impingement. X-rays can also rule out problems other than impingement.
  • Other Tests. Magnetic resonance imaging (MRI), arthrograms, or an injection can help your doctor learn whether you have impingement.

How Is Impingement Treated?

Rest is the first treatment for impingement. If an activity hurts, don't do it. Otherwise, you may prevent healing and increase pain. Work with your
health care provider to treat the pain.

Other treatments include:

  • Ice, heat, and medication
  • Physical therapy
  • Exercises
  • Injectlon therapy
  • Surgery (as a last resort)

Your Shoulder in Motion

Many bones, muscles, and tendons in your shoulder let you reach, swing, and lift. A group of muscles and tendons; called the rotator cuff, allows all the parts to work together. As you raise your arm, the narrow space within the shoulder joint naturally compresses. Over time, this may irritate a muscle or tendon, leading to swelling. The swelling may then narrow the space more, causing pinching and impingement.

When Shoulder Problems Begin

Repeated overhead shoulder movement can cause aching and inflammation (swelling) in your shoulder. If you keep using your shoulder, the pain can worsen. A number of things can then set the impingement cycle in motion.

Overuse

Continuing shoulder use without allowing time to rest can lead to swelling and pinching of tendons and the bursa.

Acromion Shape

A hooked acromion can press down on the tendons and the bursa, adding to irritation and causing inflammation.

 

Other Causes

Wear and tear can cause instability (strained shoulder ligaments that lead to looseness and swelling).

How Impingement Develops

Impingement can take time to develop. At first, you may feel a minor pain in your shoulder tendons. These tough strands of fibrous tissue connect muscle to bone. As the tendons become irritated, your body sends more blood to the area. This causes inflammation, which narrows the space even more. This inflammation is called tendinitis.

If you don't rest your shoulder, you may trigger another problem. The bursa, normally a flat membrane, fills with fluid. This is called bursitis. It causes more swelling and compression within the shoulder joint.

Both tendinitis and bursitis decrease the space within your shoulder joint. You may feel a painful pinching when you use your shoulder. And if you don't allow time to heal, impingement pain can increase.

Your Role in Healing

Rest. That's the best way to start healing. But in this case, rest means limiting-not eliminating-shoulder motion. This is called active rest. Once you can get back to your normal activities, you may then change your shoulder movements to help prevent future problems.

Balancing Rest and Motion

Active rest is key. Avoid overhead activities. But don't stop using your shoulder completely. This can cause it to "freeze" or stiffen. The pendulum exercise shown below is one way to help prevent this.

The pendulum exercise keeps your shoulder flexible without adding to impingement. Here's how to do it:

  1. Lean over with your good arm supported on a table or chair.
  2. Relax the arm on the painful side, letting it dangle straight down.
  3. Slowly begin to swing the relaxed arm. Move it in a circle, back and forth, and side to side.

Note: Spend about 5 minutes doing the exercise, 3 times a day. Change direction
after about a minute of motion. Or follow your health care provider's instructions if they differ from these.

Using Your Shoulder Wisely

Making changes in how you use your shoulder can lessen your chances of impingement. The ideas below focus mainly on preventing repetitive motion injuries (RMIs). But remember the first treatment rule: If it hurts, don't do it.

Position Yourself Well

  • Avoid raising your arms when working above shoulder level.
  • Use a stool or stepladder when needed to prevent awkward reaching.
  • Keep your work within easy reach. This helps you avoid stretching or twisting your arms and shoulders.

Change Your Tasks 

  • Vary your on-the-job activity to help reduce the risk of RMIs.
  • Give your shoulder enough time to rest and recover from stressful tasks.
  • If one task causes you to feel pain, make sure you rest before continuing to work.

Avoid Force 

  • Avoid heavy lifting, pushing, pulling, or other activities that could strain shoulder muscles and tendons. Get help when needed, or use dollies and wheelbarrows.
  • Find the best tools for each activity. The best tool lets you use the least force.
  • Rest before repeating a task that requires a lot of force. The more frequent the force, the greater the risk of RMIs. If possible, avoid the task completely.

Treatment Options for Pain

Impingement can be treated a number of ways. Your health care provider will discuss your treatment options with you. Many steps can be taken to relieve pain on your own at home. But in other cases, you may need treatment that requires your health care provider's help.

Finding the Best Treatment for You

Ice, heat, and medication can help relieve shoulder pain quickly. But if your pain continues, call your health care provider. Keep in mind that no two people are alike. You may need to try a few pain relief methods before you find the best one for you. Your Health care provider will help you pick.

Ice

Ice reduces inflammation and relieves pain. Apply an ice pack for about 15 minutes at a time, 2 or 3 times a day. You can also use a bag of frozen peas instead of an ice pack. The bag will mold nicely to the shape of your shoulder. A pillow placed under your arm may make you more comfortable.

Heat

Heat may soothe aching muscles, but it won't reduce inflammation. You can use a heating pad or take a warm shower or bath. Do this for 10 minutes at a time.
Note: Avoid heat when first injured. Heat is best when used for warming up before an activity.

Medication

Try over-the-counter pain relievers. Aspirin, ibuprofen, or naproxen can help reduce pain and inflammation. Your doctor also may prescribe pain relievers. He or she will discuss what to take, how much, and when. Be sure to follow all instructions.

Electrical Stimulation

Electrical stimulation can help reduce pain and inflammation. Your health care provider attaches small pads to your shoulder. A mild electric current then flows into your shoulder. You may feel tingling, but it doesn't hurt. This treatment is often done 3 times a week for 10 to 20 minutes at a time.

Ultrasound

Ultrasound can reduce pain. Your health care provider applies a slick gel or a medicated cream to your shoulder. Then he or she rubs a small device over the area. Sound waves from the device help loosen tightness. Ultrasound is painless. It's often done 3 times a week for 4 to 8 minutes at a time.

Injection

You may have an injection if other pain relief doesn't work. Your doctor numbs a small spot on the shoulder. He or she then injects cortisone (an anti-inflammatory medicine) into the shoulder. It can take a few hours or even a couple of days before the injection helps. But the effect can last for weeks.

If You Need Surgery

If your symptoms aren't relieved by other treatment, you may need surgery. Surgery creates space where impingement has caused narrowing within your shoulder. In most cases, the procedure is done arthroscopically. This technique uses tiny incisions, speeding your recovery.

Preparing for Surgery

You need to prepare ahead of time for shoulder surgery. You may have general anesthesia (when you "sleep" during surgery). Preparing can help limit complications from anesthesia. Follow all your doctor's instructions.

  • Stop taking aspirin or other anti- inflammatory medication before surgery as directed.
  • Tell your doctor about all medication you take. Ask whether you should stop taking any before surgery.
  • Don't eat or drink after midnight the night before surgery.
  • Arrange for a friend or family member to give you a ride home after surgery.

Giving Your Shoulder the Space to Move

Surgery for impingement helps free up space within your shoulder. This allows pain-free motion. The surgery is often done in 3 steps. You probably can go home the same day you have surgery.

As You Recover

You will be taken to a recovery area after surgery. A doctor or nurse will give you medicine to help relieve discomfort. Before leaving the surgery center, make sure you know how to care for yourself at home. Taking medicine, using ice, and keeping your arm in a sling as instructed will help you recover faster. It may take a few months before your shoulder is fully healed.

A Lifetime of Shoulder Movement

Impingement may have kept you from working or enjoying your favorite activities. But you can feel better. Work with your health care provider to relieve pain. And do your part to learn stretching and strengthening exercises. Finally, find new ways to do familiar tasks. Adjusting your routine as you work and play may help keep other shoulder problems from developing.