Shoulder Impingement FAQs

Shoulder impingement is caused by the narrowing of the space above the head of the humerus or the shoulder joint. This may be caused due to bone spurs of the acromion or the clavicle. This impingement and narrowing, leads to decrease space for the rotator cuff tendon leading to injury and tear in the rotator cuff tendon.

Acromial spur is an osteophyte formed on the under surface of the acromion, which is lateral process out of the shoulder blade of the scapula.  This acromial spur may dig into the rotator cuff underneath causing inflammation or tearing of the rotator cuff.  If the patient does not get better for his symptoms from acromial spur by conservative means, these patients may need surgical treatment to recover completely.

There are certain clinical signs that a physician does to confirm or deny the possible presence of impingement or narrowing of the space above the head of the humerus in the shoulder joint. These signs when positive are suggestive of impingement syndrome. Such patients needs management according to their symptoms in the form of medications, cortisone injection or further investigation using x-rays and MRI to confirm the finding. They may need surgery if the symptoms are severe and are not relieved by conservative means.

Shoulder impingement is essentially treated with anti-inflammatory medications with or without cortisone injection, with physical therapy. Ice and heat can be used for the pain of shoulder impingement. If the pain is of acute onset and severe, ice may be helpful but in the long run the heat may be also helpful in decreasing the pain. Occasionally an alternating therapy of ice and heat may be helpful in such patients.

It is unusual to have numbness due to shoulder impingement. The numbness in hand is mostly due to nerve issues which can be pinged either in the neck or at the elbow or wrist. Such patients should discuss the possibility of other causes of pain or numbness with their physician.

Impingement is usually caused by bone spurs in the shoulder joint above the head of humerus. The bone spurs once formed usually do not resolve unless they have been cleaned out surgically. In most cases once the surgery is done to clean the bone spurs, the impingement usually does not recur.

Occasionally patients, especially youth involved in sporting activities like baseball, basketball, tennis, volleyball, may have pinching of the rotator cuff on the inside of the rotator cuff joint between the head and the cup of the shoulder joint.  This is called internal impingement. Occasionally this impingement may be severe enough to cause tearing of the rotator cuff.

This impingement may also injure the cartilage around the cup of the shoulder joint called the labrum leading to labral tears. These patients may also occasionally need surgery to fix the problem.  Most of the time these patients are treated conservatively with the help of physical therapy and rehabilitation.

Acromion is a lateral process out of the shoulder blade of the shoulder joint.  On x-rays, it has been classified into four types.  Type II is the most common type and is gradual curve along the head of the shoulder.  Type II acromion may occasionally cause impingement of the shoulder joint.  The type III acromion is the one which is usually involved with impingement syndrome of the shoulder joint as it is curved like a hook over the rotator cuff and lead to injury and possible tearing of the rotator cuff.

Acromion is a hook-like process present laterally out of the shoulder blade of scapula bone of the shoulder joint.  It acts like a hood over the rotator cuff and gives it protection. The rotator cuff runs underneath surface of acromion.  Occasionally the spurs in acromion or the spurs out of the acromioclavicular joint, a joint formed between acromion and clavicle, may cause injury to the rotator cuff leading to inflammation called tendinitis or tearing of the rotator cuff.

Recovery from bone surgery is quicker than a rotator cuff surgery.  Patients are usually put in sling for a couple of days after the surgery.  They can be out of sling and use their extremity as much as they can tolerate the pain. They usually recover completely in six to eight weeks and can perform unrestricted activities after that.  Patient involved in professional sports or heavy activities may need longer rehabilitation period.

Patients presenting with impingement or inflammation of the rotator cuff tendon due to bone spurs from the acromion injuring the rotator cuff, these patients sometimes need surgery to clean up the bone spurs.  During this surgery the bone spurs from the under surface of the acromion are removed.  This procedure is called subacromial decompression.

Bursitis of the shoulder usually involves subacromial bursa or the bursa between the rotator cuff and the shoulder bone or acromion.  It usually presents with pain and swelling.  The pain is worse with overhead activities and rotation.  It is treated with anti-inflammatory medications with or without cortisone injection in the subacromial space of the shoulder joint.

If the patient does not improve with conservative means, then a surgical excision of the bursa as well as the pathology causing it in the form of bone spurs may have to be cleaned up.  These patients may also have rotator cuff tear due to the digging of the bone spur on to the rotator cuff.