Shoulder impingement, also called subacromial or rotator cuff impingement, is part of a spectrum of problems with the rotator cuff. You may have heard people call it “tendinitis” or “bursitis,” but that is only one component of the issue.
Impingement of the rotator cuff tendons
The rotator cuff is a series of muscles that come off the shoulder blade. Those muscles become tendons that travel under the tip of the shoulder blade to insert on the humeral head. Problems with the rotator cuff can range from impingement of the tendons on the acromion to a partial tear of the tendon to a complete tear.
In subacromial impingement, the rotator cuff tendons become inflamed as they rub against the undersurface of the acromion. The bursa (the fluid–filled sac between the rotator cuff and the acromion) also becomes inflamed, causing shoulder pain. In some patients, intrinsic degeneration within one of the rotator cuff tendons exists.
Signs and symptoms of shoulder impingement
Shoulder and upper arm pain is the hallmark of impingement syndrome. The pain is usually worse with activities, such as reaching overhead, reaching out away from the body or reaching behind the back. You might have pain that wakes you up at night.
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Tests for shoulder impingement and rotator cuff tears
Physical examination tests can help make the diagnosis. The doctor will put your shoulder in certain positions to recreate your symptoms and reproduce the pain. He will also test your rotator cuff strength to rule out a tear. Occasionally the physician will inject lidocaine, a numbing medicine, into the space between the rotator cuff and the acromion to see if the pain goes away.
Physical therapy and injections for shoulder impingement
Treatment of rotator cuff impingement usually involves physical therapy or injections but does not require surgery. Rest from offending activities, ice, and anti-inflammatory medications can be helpful. Physical therapy can be very helpful, if not critical, to relieve the patient’s symptoms. Typically these are low-weight, high-repetition exercises in a variety of different positions to strengthen the rotator cuff and the surrounding muscles of the shoulder and upper back. Occasionally a cortisone shot into the subacromial space can be helpful to augment the improvement produced with the physical therapy exercises.
Surgery as a last resort
Occasionally shoulder surgery is needed as a last resort when the symptoms are not improving with nonsurgical treatment.
In this video, I describe shoulder impingement, what symptoms you might have, how we can make the diagnosis, and how you can get better and back to sports and exercise.
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