Shoulder impingement, also known as rotator cuff tendonitis, is a fairly common condition that many people develop. When you have shoulder pain, it can make it hard to do your usual activities, like playing sports or even lifting things. In fact, shoulder impingement is one of the most common causes of shoulder pain. Sports medicine experts at The Ohio State University Wexner Medical Center in Columbus, Ohio, will diagnose and treat this condition with precision to help you get back to the activities you enjoy.
What is shoulder impingement?
To understand the condition, it’s important to understand how the shoulder works. Your shoulder is a “ball-and-socket” joint made up of muscle and other soft tissue, like cartilage and bone. The shoulder has three bones in it including the upper arm bone (humerus), the shoulder blade (scapula) and the collarbone (clavicle). The rotator cuff surrounds your shoulder joint and helps you rotate and move your arm.
Shoulder impingement is an orthopedic condition that occurs when the scapula (shoulder blade), the bone at the top of the shoulder, compresses (impinges or pinches) on the rotator cuff with overhead arm movement, causing pain and irritation. The small space between these bones makes the rotator cuff prone to being pinched.
Care for shoulder impingement
Shoulder impingement involves inflammation around the rotator cuff. Ryan Rauck, MD, an orthopedic surgeon, explains what treatment options are available for this common shoulder condition.
Types of shoulder impingement
There are different types of shoulder impingement. Impingements can be classified by their location, either external or internal, and by their underlying cause (called primary or secondary impingement).
- External impingement (subacromial impingement) occurs when the rotator cuff is pinched in some portion of the shoulder tissues itself.
- Internal impingement happens when rotator cuff tendons get pinched between the top of the rotator cuff (humeral head) and the glenoid rim. The glenoid rim is the edge of the shallow socket in your shoulder blade where your arm bone fits.
- Primary impingement happens because of structural or anatomical problems in your shoulder (usually due to narrowing). This can occur due to conditions such as bone spurs or other anatomical abnormalities.
- Secondary impingement occurs when your shoulder anatomy is otherwise normal, but the impingement occurs when you move your arm.
By knowing the type of shoulder impingement, our experts can figure out the best treatments for you.
What causes shoulder impingement?
Most people with shoulder impingement don’t have any specific shoulder injury associated with the condition.
Shoulder impingement is thought to involve compression (impingement) of the rotator cuff tendons against the bones, bone spurs and ligaments surrounding the shoulder joint. This may involve some wear and tear or partial tearing of the rotator cuff tendons themselves. It leads to pain and inflammation of the rotator cuff and bursitis over the rotator cuff.
Risk factors of impingement syndrome
There are some risk factors that could increase the likelihood of developing shoulder impingement. A risk factor is anything that can increase your chances of developing a condition.
Some of these risk factors may include:
- Certain occupations that require repeated overuse of the shoulder joint
- Athletes of certain sports
- Previous injury or trauma to the area
- Tobacco use
- Certain sleeping positions
- Acromion shape (the acromion forms the highest point of the scapula, or shoulder blade)
- Older age
Your doctor will determine if any of these risk factors could influence a shoulder impingement diagnosis.
Shoulder impingement symptoms
Shoulder impingement can cause discomfort and limit your ability to move your arm freely. Understanding the symptoms can help you recognize when to seek medical help.
Symptoms of shoulder impingement may include:
- Difficulty or inability when lifting the arm overhead
- Pain that worsens with certain activities, including work or sports
- Pain is located down one side of the shoulder
- Pain that prevents or makes it challenging to lie on one shoulder or sleep on it
- Stiffness or weakness in the shoulder joint
If you have any symptoms of shoulder impingement and they don’t improve, you should see a doctor to get a proper diagnosis and treatment plan.
How is shoulder impingement diagnosed?
A diagnosis for shoulder impingement begins with a shoulder expert gathering a detailed medical history and conducting a thorough physical examination. At the Ohio State Wexner Medical Center, our shoulder specialists will perform a comprehensive exam to assess the range of motion, strength and any tenderness or pain in the shoulder joint. They will ask about your symptoms, including the onset, location and intensity of pain in the shoulder.
During the exam, the doctors may perform specific tests. This might include asking you to raise your arm and rotate it in different directions, and they may apply gentle pressure to check for discomfort.
If further evaluation is needed, diagnostic imaging such as X-rays and magnetic resonance imaging may be ordered. This will be used to confirm a diagnosis and identify any other associated injuries, such as a rotator cuff tear.
Shoulder impingement treatment
Most people who have shoulder impingement don’t need surgery to relieve pain, improve motion, improve shoulder function and regain the functions of work, play and daily life.
There are nonsurgical and surgical treatment options for shoulder impingement. Your doctor may recommend a combination of one or more options.
Nonsurgical treatments can include:
- Rest and activity modification
- Using ice or heat on the affected area
- Taking anti-inflammatory medications, including nonsteroidal anti-inflammatory drugs (NSAIDs)
- Cortisone injections
- Physical therapy, either at home or in-office
Surgical treatment
If nonsurgical shoulder impingement treatments fail, surgeons at the Ohio State Wexner Medical Center can perform minimally invasive arthroscopic shoulder surgery using a camera and small incisions.
This procedure involves removing inflamed bursae (small, fluid-filled sacs) in the shoulder, removing bone spurs that contribute to impingement and evaluating the rotator cuff to make sure it doesn’t have a tear.