SHOULDER IMPINGEMENT

What is shoulder impingement?

Shoulder impingement is a painful condition that develops due to friction of the rotator cuff against the humerus and the outer rim of the shoulder. The constant rubbing of the rotator cuff can lead to inflammation, pain and swelling.

Treatment for shoulder impingement is recommended when pain persists for several weeks, disrupts sleep, impairs daily functioning, or leads to joint weakness.

What is the primary cause of shoulder impingement?

Shoulder impingement develops when the upper, outer part of the shoulder (acromion) painfully pinches the rotator cuff underneath it. An irritated rotator cuff begins to swell, similar to any part of the body that becomes inflamed. Due to inflammation and swelling, space beneath the acromion begins to constrict. As a result, increased pressure is applied on the acromion.

Bone spurs on the acromion bone can also cause shoulder impingement due to the confined space where the rotator cuff rests. Shoulder impingement is common among athletes and those who participate in activities involving overhead rotational movements, such as tennis, baseball, volleyball and swimming.

What are the symptoms of shoulder impingement?

Common symptoms of shoulder impingement include:

• Shoulder pain when lifting the arm overhead or reaching behind the back
• Shoulder pain that may radiate down the upper arm
• Pain that worsens with repetitive shoulder use
• Weakness in the affected shoulder
• Difficulty performing daily activities such as dressing or lifting objects
• Shoulder pain at night, particularly when lying on the affected side
• Reduced range of motion in the shoulder

How does Dr van Niekerk check for shoulder impingement?

Dr van Niekerk will first inquire about your medical history and carry out a physical exam to determine the cause of pain and joint tenderness. In addition, he may decide to order additional diagnostic tests such as:

• X-ray imaging determines whether you have arthritis. The formation of bone spurs or a difference in the anatomical appearance of the margin of the bone, a point where the rotator cuff joins, could cause shoulder impingement.
• MRI scan reveals a torn rotator cuff tendon or inflamed bursae.

How do you treat shoulder impingement?

Treatment for shoulder impingement aims to reduce pain, improve shoulder mobility, and restore normal function.

In most cases, treatment begins with conservative measures such as rest, activity modification, anti-inflammatory medication, physiotherapy, and corticosteroid injections. These approaches help reduce inflammation and improve strength and flexibility of the shoulder.

If symptoms persist despite non-surgical treatment, Dr van Niekerk may recommend arthroscopic shoulder decompression. This minimally invasive keyhole procedure involves making small incisions in the shoulder to access the joint and creating more space for the rotator cuff by removing part of the acromion.

During surgery, other associated conditions may also be addressed if present, such as a rotator cuff tear, shoulder arthritis, or inflammation of the Arthroscopic surgery is typically recommended when symptoms are ongoing, structural abnormalities are present, or bone spurs are contributing to impingement.

What are the benefits of treating shoulder impingement?

Treatment for shoulder impingement, whether conservative or surgical, offers several important benefits, including:

• Reduction in shoulder pain and inflammation
• Improved range of motion and shoulder flexibility
• Restored strength and function of the shoulder
• Ability to return to daily activities and sports with less discomfort
• Improved sleep quality due to reduced night pain
• Prevention of further shoulder damage or worsening of symptoms
• In cases of surgery, increased space for the rotator cuff which reduces ongoing impingement