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Consult our MOH-accredited shoulder impingement specialist for an accurate diagnosis & personalised treatment plan.
Shoulder Impingement Syndrome
Shoulder impingement syndrome is a condition that affects the shoulder joint, causing pain and limiting movement. It occurs when the tendons of the rotator cuff muscles become irritated and inflamed as they pass through the narrow space between the top of the upper arm bone (humerus) and the shoulder blade (scapula). This often leads to discomfort, especially when lifting the arm or performing overhead activities.
Are your symptoms affecting your quality of life? Consult our shoulder impingement specialist for an accurate diagnosis & personalised treatment plan today.
Dr Dennis Ng Zhaowen
Causes of Shoulder Impingement Syndrome
Various factors can cause shoulder impingement syndrome, including structural problems, lifestyle habits, and ageing. Knowing these causes can help you find the problem and treat it well.
- Structural Abnormalities: Bone spurs or structural abnormalities in the shoulder, such as a curved or hooked acromion, can reduce the space through which the rotator cuff tendons pass. This narrowing increases the likelihood of the tendons and bursa being compressed and irritated.
- Repetitive Overhead Activities: Repetitive overhead activities, often seen in athletes such as swimmers, tennis players, and weightlifters, can cause wear and tear on the rotator cuff tendons. This overuse can lead to inflammation and impingement over time.
- Poor Posture: Postural problems, such as forward head posture or rounded shoulders, can result in the shoulder blade and the acromion being misaligned. Poor posture, such as a forward head stance or rounded shoulders, can cause misalignment of the shoulder blade and acromion. This misalignment can make impingement easier, especially when moving or reaching with the arm.
- Age-Related Changes: As people age, the tendons in the shoulder can degenerate and lose elasticity. This degeneration makes the tendons more prone to tears and inflammation, which can contribute to the narrowing of the subacromial space and lead to impingement.
- Acute Shoulder Injuries: Direct injuries to the shoulder, such as falls or impacts, can cause immediate swelling and inflammation in the shoulder joint. This swelling can temporarily narrow the subacromial space and lead to impingement symptoms.
- Muscular Imbalances: Imbalances in the muscles around the shoulder, particularly weakness in the rotator cuff muscles or tightness in the shoulder muscles, can alter the dynamics of shoulder movement. This imbalance can lead to improper shoulder blade positioning and increase the risk of impingement.
- Occupational Risk Factors: Jobs that require frequent overhead lifting or repetitive shoulder movements can increase the risk of developing shoulder impingement syndrome. This is common in painting, construction, and manual labour professions.
Symptoms of Shoulder Impingement Syndrome
Shoulder impingement syndrome can cause mild to severe pain, affecting everyday functioning and quality of life. Early detection helps diagnose and treat these problems.
- Shoulder Pain
Pain is typically felt in the front and side of the shoulder and can extend down the arm. The pain is often worse with overhead activities and can also be more pronounced at night, especially when lying on the affected shoulder. - Limited Range of Motion
People with shoulder impingement syndrome may experience a reduced range of motion in the affected shoulder. This can make it difficult to perform everyday tasks, such as combing hair, fastening a bra, or reaching for items on high shelves. - Weak Shoulders
Weakness in the shoulder muscles, particularly the rotator cuff, can occur due to pain and inflammation. This weakness can make lifting objects challenging or performing activities requiring shoulder strength. - Swelling and Tenderness
Swelling and tenderness around the shoulder joint can accompany the pain. The area may be sensitive to touch, and there might be visible swelling or inflammation. - Stiffness
Stiffness in the shoulder joint is another common symptom. This stiffness can be most noticeable in the morning or after periods of inactivity. It can contribute to the overall limitation in the shoulder’s range of motion. - Clicking or Popping Sensation
Some people may experience a clicking or popping sensation when moving the shoulder. This can indicate tendon or bursa irritation as they move through the narrowed subacromial space.
Diagnosis of Shoulder Impingement Syndrome
Shoulder impingement syndrome is diagnosed through medical history, physical exam, and imaging. An accurate diagnosis is recommended for effective treatment.
Medical History
The diagnosis process begins with a detailed medical history. The shoulder specialist will ask about the patient’s symptoms, including the pain’s onset, duration, and intensity. They will also inquire about any recent injuries, repetitive activities, or changes in physical activity that might have contributed to the symptoms. A history of similar issues or other shoulder conditions will also be considered.
Physical Examination
During the physical examination, the shoulder specialist will assess the shoulder’s range of motion, strength, and any signs of swelling or tenderness. Specific tests may be conducted to evaluate shoulder function and identify the source of pain. These tests include:
- Neer Impingement Test: The patient’s arm is raised while the scapula is stabilised. Pain during this movement suggests impingement.
- Hawkins-Kennedy Test: The patient’s arm is flexed at 90 degrees, and the elbow is bent. The shoulder specialist then internally rotates the arm. Pain indicates potential impingement.
- Empty Can Test: The patient is asked to elevate their arms in the scapular plane with thumbs pointing downward, simulating an empty can. Downward pressure is applied, and weakness or pain can indicate rotator cuff involvement.
Imaging Tests
Imaging tests often confirm the diagnosis and rule out other potential causes of shoulder pain. These may include:
- X-rays: X-rays can reveal bone spurs, structural abnormalities, or arthritis that might contribute to impingement. They help visualise the bones but do not show soft tissues like tendons and bursae.
- MRI (Magnetic Resonance Imaging): An MRI provides detailed images of the shoulder’s soft tissues, including the rotator cuff tendons and bursae. It is helpful in identifying inflammation, tears, or other soft tissue abnormalities.
Treatment Options
Treatment varies depending on the severity of the condition and the patient’s response to initial treatment. Both non-surgical and surgical treatments are available.
Non-Surgical Treatments
Non-surgical treatments reduce inflammation, relieve pain, and improve shoulder function.
Rest and Activity Modification: Avoiding activities that exacerbate the symptoms, especially those involving repetitive overhead movements, can help reduce inflammation and pain. Resting the shoulder allows the tendons and bursae to heal.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter NSAIDs, such as ibuprofen or naproxen, can help reduce pain and inflammation. These medications should be used as directed and may be recommended for short-term relief.
- Injections: Corticosteroid injections can be administered directly into the subacromial space to reduce inflammation and relieve pain. These injections can effectively reduce symptoms, especially in cases where other non-surgical treatments have not provided sufficient relief.
Surgical Treatments
If non-surgical treatment fails or the shoulder is structurally damaged, surgery may be considered. Rotator cuff surgery relieves impingement by increasing tendon space.
- Arthroscopic Subacromial Decompression: This minimally invasive procedure involves using an arthroscope, a small camera inserted into the shoulder joint, to visualise and remove the inflamed bursa, as well as any bone spurs or other structures causing the impingement. This procedure helps create more space for the tendons to move freely, reducing pain and improving shoulder function.
- Rotator Cuff Repair: If the rotator cuff tendons tear, surgical repair may be necessary. Depending on the extent of the tear, this can be done arthroscopically or through an open surgical approach. During the procedure, the torn tendons are reattached to the bone using sutures or anchors to restore shoulder function and strength.
Prevention of Shoulder Impingement Syndrome
Preventing shoulder impingement syndrome involves adopting healthy habits and practices to maintain shoulder health. These include:
- Maintaining Good Posture - Proper posture helps align the shoulder joint, reducing the risk of impingement. Avoid slouching and practice exercises that strengthen the upper back and shoulder muscles. Make ergonomic adjustments to workspaces and activities to reduce strain on the shoulder. This can include adjusting the height of workstations, using supportive chairs, and ensuring proper body mechanics during tasks.
- Use Proper Techniques - It is important to limit activities that involve repetitive overhead movements, which can strain the shoulder. Incorporate regular breaks and alternate tasks to reduce continuous stress on the shoulder joint. Proper techniques and gear can also help minimise the risk of overuse injuries.
- Strengthening Shoulder Muscles - Regular exercises to strengthen the rotator cuff and shoulder muscles can help maintain shoulder stability and prevent impingement. Focus on a balanced exercise routine that includes both strengthening and stretching exercises.
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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road #08-41
Singapore 329563
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6 Napier Road #07-15
Singapore 258499
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Frequently Asked Questions (FAQs)
How long does it take to recover from shoulder impingement syndrome?
Recovery time varies. Non-surgical treatments may take several weeks to months, while surgical recovery can take several months, including physical therapy, to restore strength and function.
Is shoulder impingement syndrome the same as rotator cuff tendinitis?
While both conditions involve inflammation of the rotator cuff tendons, shoulder impingement syndrome specifically refers to the compression of these tendons in the subacromial space. Rotator cuff tendinitis is the inflammation of the tendons without necessarily involving impingement.
What are the risks associated with delaying treatment for shoulder impingement syndrome?
Delaying treatment can lead to increased pain, reduced shoulder function, and the potential for more severe damage to the rotator cuff tendons, which might require more invasive treatments like surgery.
Are there any long-term effects of shoulder impingement syndrome?
If left untreated, shoulder impingement syndrome can lead to chronic pain, persistent weakness, and reduced range of motion. Long-term impingement can also cause rotator cuff tears and other complications.