Introduction:
The shoulder is one of the largest and most complex parts of the human body. The shoulder is made up of several joints along with tendons, ligaments, and muscles. As the shoulder contains many different structures, they are prone to various problems. The shoulder joint is extremely unstable, hence increasing the risk of tissue breakdown.
The shoulder is a ball and socket type of joint that allows a great range of movements in the arm. The shoulder contains a cap-like socket to which the arm is fixed with the help of four muscles and tendons, altogether called a rotator cuff. The socket contains fluid for lubrication. The fluid-containing sac that protects the tendon is called a bursa. The rotator cuff slides freely in the sac during arm movements. Shoulder impingement is a frequent cause of shoulder pain and irritation. Any discomfort in the shoulder joint limits arm movement and affects the routine lifestyle.
What Is Shoulder Impingement?
Shoulder impingement is a condition where the rotator cuff is pinched. This makes the rotator cuff compressed, and it hampers the free gliding movement in the sac. The tendons and the sac become irritated, and the rotator cuff becomes swollen.
Impingement takes time to develop. Initially, minor pain is felt, but if the irritation continues, inflammation develops in the tendon and bursa. This inflammation is called tendonitis and bursitis. Further, the space within the shoulder joint decreases, and the pain is exaggerated.
Since it is common in swimmers, it is also called a swimmer's shoulder.
What Are the Types of Shoulder Impingement?
The four types of shoulder impingement are:
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Anterior subacromial impingement.
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Posterosuperior glenoid rim or internal impingement.
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Subcoracoid impingement.
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Suprascapular nerve impingement.
What Are the Causes of Shoulder Impingement?
Shoulder impingement may sometimes happen without any apparent cause. But there are some risk factors associated, and they are:
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Physical Loading: Repetitive and overhead activities using the arm over the head for a long time. Examples are swimming, playing baseball, and tennis.
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Injury: Pain may develop as a result of minor damage.
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Age: Degenerative changes occur as age advances. Bone spurs may develop and cause irritation and pain.
What Are the Symptoms of Shoulder Impingement?
Symptoms of shoulder impingement take place over the course of time.
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Pain: Minor pain develops, and the pain may radiate to the arm. There may be a sudden pain when the arm is raised or when lifting heavy objects. Sportspersons may have pain while playing and using their arms to throw the ball, hit with a bat, and swim. The pain may worsen during the night.
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Swelling and Tenderness: The inflammation in the rotator cuff region may cause localized swelling and tenderness.
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Stiffness: Due to pain, there is decreased range of motion, which further causes stiffness in the joint.
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Muscle Cramp: There will be a sudden catch in the muscle while rotating or raising the arm.
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Arm Weakness: Inability to lift the hand to do daily activities.
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Sleeplessness: Sleep may be disturbed because of pain. Unable to sleep on the side of affected shoulders.
How to Diagnose Shoulder Impingement?
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Medical History: A thorough evaluation of the patient's history is crucial to understand the condition better.
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Physical Examination: Physicians may palpate the shoulder area and try to move the arms in different ways to check for tenderness, stiffness, and arm strength and rule out any deformities. They may also perform two tests to identify the shoulder impingement.
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Neer Impingement Test: It is designed to reproduce symptoms of rotator cuff impingement through flexing the shoulder.
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Hawkins-Kennedy Test: It is performed by a sudden flexing of the patient's relaxed arm. It is considered to be a highly sensitive test.
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Imaging Tests: X-rays may be helpful to check for any bone spurs and rule out other conditions like arthritis and fracture. Ultrasound is used to check for inflammation in the bursa. If there is a severe rotator cuff injury, MRI (magnetic resonance imaging) scan can be used to better look into the shoulder joints.
How to Treat Shoulder Impingement?
The main goal of treatment is to reduce swelling and pain. Shoulder impingement can be treated in two ways:
1. Non-surgical:
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Rest: Giving minimal activities to the shoulder for a few days gives time for the cuff and bursa to heal by themselves.
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Medication: NSAIDs (non-steroidal anti-inflammatory drugs) are prescribed to alleviate pain and swelling.
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Physical Therapy: Stretching exercises and minor rotations are performed to restore normal function.
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Ice Pack: Placing ice packs for 10-15 minutes a day can reduce the symptoms efficiently.
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Steroid Shots: Steroid injection is given directly into the bursa, and it is a very effective anti-inflammatory agent. It is a choice when physical therapy and medication do not work. Cortisone preparation is the preferred steroid.
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Patient Education: The patient must be taught about home care and always have support for shoulders while working or sitting for a long time.
2. Surgical:
Surgical treatment of shoulder impingement mainly focuses on increasing the gap in the bursa. Shoulder arthroscopy (minimally invasive technique) is preferred because it reduces potential complications and healing time.
- A small incision is made, and thin surgical instruments are used with the help of the fiber optic imaging technique. The damaged or inflamed part of the bursa is removed.
- In some cases, the protruding acromion (tip in the outer edge of the shoulder bone) is shaved.
- The incisions are closed with stitches or staples and covered with a dressing. The recovery after surgery is usually between three to six months.
- Some complications after surgery are shoulder stiffness and continued pain.
- After the treatment, it is advisable to do some light exercises to strengthen the arm and shoulder muscles.
Conclusion:
Shoulder impingement is a common condition that provokes shoulder pain. This state can produce a fair amount of pain and discomfort that can hinder normal arm activities. The combination of weakness and stiffness in the shoulder muscles worsens the condition in due course. Addressing shoulder impingement is necessary to avoid shoulder tears. Hence a comprehensive treatment protocol is followed as soon as the disease is diagnosed.
