INTRODUCTION

• Shoulder impingement is one of the most common shoulder pathologies

• It is characterized by the pinching of the shoulder on one of the bones called the acromion

• The pathology resulting from shoulder impingement involves three important structures

• Rotator cuff tendon

• Subacromial bursa

• Acromion bone

• What happens is the structures between the proximal humerus and acromion (subacromial bursa and rotator cuff tendon) get pinched, causing inflammation, swelling, tendinitis, and pain 

• The repetitive rubbing of the rotator cuff tendon and subacromial bursa leads to rotator cuff tendinitis and subacromial bursitis. Both of these processes are very painful and are worse with overhead activities

 

CAUSES

• Repetitive overhead activities can predispose to shoulder impingement, subacromial bursitis, and rotator cuff tendinitis

• Having a downsloping acromion is a predisposing factor to developing shoulder impingement

• Weak or deconditioned rotator cuff muscles lead to excessive shoulder motion, causing the shoulder to rub against the acromion and irritate the subacromial bursa and rotator cuff tendon

 

SIGNS AND SYMPTOMS

• Pain in the side of the shoulder with certain arm positions, including overhead work

• Tenderness over the lateral or side of the shoulder, next to the acromion bone

TREATMENT

• A course of physical therapy or a home exercise program is the mainstay of treatment for shoulder impingement. The idea is that strengthening the rotator cuff tendons will prevent the shoulder from excessively moving an decreasing the likelihood of the shoulder rubbing against the acromion 

• Anti-inflammatories such as ibuprofen may help decrease inflammation from the rotator cuff tendinitis and subacromial bursitis

• A corticosteroid injection in the subacromial space can locally decrease the inflammation and pain

• Orthobiologics such as platelet rich plasma (PRP) can be considered for rotator cuff tendinitis that is refractory to conservative management. The theory behind this is that PRP can deliver growth factors to the degenerative rotator cuff tendons which have poor blood supply and healing potential. This may result in healing and decreased pain

• Surgery can be considered if patients fail at least 6 months of conservative management. Surgery consists of an arthroscopic shoulder surgery called a subacromial decompression. The acromial bone is smoothened while the inflamed bursal tissue is debrided and removed.

 

PREVENTION

• Keeping the shoulder joint stable by maintaining strong rotator cuff tendons is the best way to prevent shoulder impingement

•  Avoiding repetitive overhead activities may decrease the chance of developing subacromial bursitis