Shoulder impingement is a frequent cause of shoulder pain, particularly during lifting or overhead activities. It occurs when the soft tissues within the shoulder (the rotator cuff) become compressed and irritated during movement, leading to inflammation, pain, and reduced shoulder function.
The bursa (a thin smooth fluid filled sac between the rotator cuff and the bone above) is the key structure compressed and when this becomes inflamed it is known as bursitis
Shoulder impingement often develops gradually and may be associated with rotator cuff degradation or changes in shoulder structure such as development of a bone spur over time. It is rarely the result of a single accident or injury. Early assessment can help identify these features and guide the most appropriate treatment.
The shoulder joint relies on smooth movement between several closely related structures, including the rotator cuff tendons, the subacromial bursa, and the surrounding bones of the shoulder.
Normally the rotator cuff (specifically the supraspinatus) glides under the acromion bone during elevation of the arm
The subacromial bursa is a thin, fluid-filled sac located in the narrow space above the rotator cuff. Its role is to reduce friction between the rotator cuff and the bone of the acromion above it.
Shoulder impingement occurs when this space becomes narrowed or irritated, causing the bursa and rotator cuff tendons to be compressed during arm elevation. Repeated irritation can lead to inflammation of the bursa (bursitis) which becomes thickened, rotator cuff tendon degradation, pain, and weakness.
A subacromial spur can develop beneath the acromion and contribute further to narrowing of the space and increased pressure on the rotator cuff.
The clinical problem of pain with repetitive or overhead use of the shoulder can also arise from other structural issues in the shoulder and may mimic impingement from bursitis and subacromial spurring. This is particularly the case in active young people (usually those less than 40 years of age) still playing sport or weights training. AC joint inflammation, bicep tendon disease or internal labral tears for example can result in similar symptoms and careful diagnosis is important.
In older people shoulder joint arthritis can mimic impingement in its early stages.
Impingement pain is not felt below the elbow, nor behind the shoulder in the shoulder blade area.
Diagnosis begins with a thorough clinical assessment, including a detailed history and physical examination. This allows assessment of shoulder movement, strength, posture, and areas of tenderness.
Imaging may be used to support the diagnosis and assess contributing factors:
Most cases of shoulder impingement can be managed without surgery. Initial treatment focuses on reducing inflammation and improving shoulder mechanics.
Non-operative treatment options may include:
While these treatments do not alter shoulder anatomy, many patients experience improvement in pain and function.
Most impingement pain will resolve with careful management unless significant structural issues exist such as rotator cuff deterioration or large bone spurs severely reducing the subacromial space.
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