Shoulder impingement syndrome describes a situation where the rotator cuff tendons and sub-acromial bursa become impinged in the sub-acromial space. The tendons and bursa may then become inflamed and painful which results in restriction of movement and weakness around the shoulder.
To understand shoulder impingement syndrome some basic knowledge about the anatomy around the shoulder is necessary.
Rotator Cuff Muscles
A group of 4 small muscles run from the shoulder blade to the top of the arm bone from a rotator cuff tendon. To get to the arm bone the tendon passes through the sub-acromial space.
The sub-acromial space is a narrow space between the accordion and the top of the upper arm bone (humerus). Located in this space are the rotator cuff tendons and the subacromial bursa (a sack of fluid that acts as a cushion).
Anything which causes narrowing of the sub-acromial space will cause the tendon and bursa to become impinged.
Possible causes of sub-acromial narrowing and shoulder impingement include:
Symptoms of shoulder impingement syndrome can include:
Shoulder Impingent can usually be diagnosed by taking a history and with physical examination. Physical examination should consider a range of movement, strength, biomechanics of the shoulder blade and arm bone and palpation. Specific tests may indicate the presence of impingement. Plain x-rays and an ultrasound may be of use in defining the state of the acromion and the tendons and bursa in the sub-acromial space.
There are two phases of management of shoulder impingement syndrome.
In this phase different treatments are used to reduce pain and maintain function.
These may include:
This phase begins as acute symptoms are settling and movement is improving. It may include some of the following modalities:
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