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Impingement Syndrome in Shoulders

Shoulder comprising three bones – upper arm bone, shoulder-blade, and collarbone, has several joints conjoined with muscles and tendons. The rotator cuff tendon connects the shoulder-blade to the arm bone by running through a narrow space.

However, if the tendon traps in this space, it repeatedly rubs against the shoulder-blade, causing pain while raising arms over the head. Tasks such as painting, lifting, swimming, tennis, and other overhead sports that require repetitive movements are possible risk factors for developing Impingement Syndrome.

Causes

Most of the times, Impingement Syndrome occurs for no recognized cause. However, factors which enhance the risk of occurrence or recurrence of the syndrome are as follows:

  • Injury
  • Ageing
  • Bone Spurs or bony growths growing from the shoulder-blade
  • Build-up of calcium deposits within rotator cuff tendon
  • Poor shoulder-blade posture

Signs and Symptoms

The common symptoms of Impingement Syndrome are as follows:

  • Pain while raising arms to shoulder height
  • Difficulty in reaching behind the back
  • Weakness of shoulder muscles

Specialist

Patients suffering from Impingement Syndrome should refer an Orthopedic.

Diagnosis

The specialist will carry out the following diagnosis to assess the condition:

History: The doctor will analyze the symptoms, medical history, and overall health condition of the patient.

Physical Examination: This involves physically examining the shoulder by raising the patient’s arm to the side, with palm facing away from the body. This posture is usually painful for patients suffering from Impingement Syndrome.

Laboratory Tests: X-Rays show Bone Spurs and other changes in bone due to injury of muscles.  X-Rays also rule out Arthritis and other reasons of shoulder pain.

Treatment Modalities Available for Management of the Disorder

Self-care measures, anti-inflammatory drugs, and physiotherapy remain the most common treatment options for Impingement Syndrome. Non-Surgical Treatments include the following:

  • Painkillers and corticosteroid injections to help in relieving pain
  • Avoiding over head arm movements and repetitive activities
  • Holding an ice-pack to the shoulder for 15-20 minutes several times in a day alleviates pain
  • Physiotherapy and exercises for shoulder-blade muscles as advised by the therapist
  •  Daily stretching in a warm shower

In most of the cases, the condition settles down after undergoing extensive therapy and medication. However, if non-surgical options fail, and symptoms persist, then the doctor may recommend surgery. Arthroscopy or Key-Hole Surgery repairs the damages occurred in the tendons and widens the space under the roof of the shoulder to avoid rubbing of the tendon against the bone.

Known Complications

If left untreated, Impingement Syndrome can lead to other severe conditions, such as, Rotator Cuff Tears, Tendinitis (inflammation of rotator cuff tendons), and Bursitis (inflammation & swelling of bursa).

Other complications include Upset Stomach, Vomiting, & Indigestion because of oral anti-inflammatory drugs. Cortisone Pills may cause side-effects, such as, Elevated Blood Sugar, Weight Gain, and Thinning of Skin.

Precautions

Patients should undertake the following precautions:

  • Avoid overhead and repetitive movements with the symptomatic shoulder
  • Provide rest to the shoulder but total inactivity will worsen the condition
  • Try to avoid injuries as it may aggravate the problem or lead to recurrence
  • Strictly follow the stretching exercises regime as directed by the therapist

Dietary and Physical Activity Requirements

Patients suffering from Impingement Syndrome should avoid repetitive activities, particularly, those tasks where the elbow moves above shoulder level. Resting the tendon in the initial stages is extremely essential. However, inactivity will lead to weakening of muscles and stiffening of shoulders. The patient should perform exercises to reach the thumb up and behind the back, followed by other stretching exercises, as suggested by the therapist.

Prevention of the Disorder from Happening or Recurring

The key to prevent Impingement Syndrome is regular exercise with focus on training rotator cuff muscles. One should also try to avoid injuries as it may lead to recurrence of the disorder.

Support and Help given by the Caregiver

Impingement Syndrome makes it difficult for patients to carry out daily life tasks, such as, reaching up overhead to wear a blouse or coat, and several other simple activities. Caregivers should provide support and assistance in such conditions and help the patient to cope with pain and discomfort.