shoulder impingement syndrome

Shoulder impingement syndrome, also known as impingement syndrome or shoulder impingement, is a condition where the top outer edge of the scapula (shoulder blade) pinches the rotator cuff beneath it. This can cause pain, especially when moving the arm.

Causes and Risk Factors

• Overhead activity, such as painting, lifting, swimming, tennis, and other overhead sports, can be a risk factor for shoulder impingement syndrome.
• The rotator cuff is a common cause of pain in the shoulder, which can happen due to tendinitis (inflammation of the rotator cuff tendons), bursitis (inflammation of the bursa), or impingement (pinching of the rotator cuff tendons between the acromion and the humerus).

Symptoms

• Pain and weakness in the shoulder, particularly when lifting heavy objects above shoulder level.
• Decreased range of motion.

What Happens

When the top outer edge of the scapula pinches the rotator cuff beneath it, it can cause pain and discomfort. This is because the space between the acromion and the humerus becomes smaller, leading to compression or pinching of the tendons or bursa within the shoulder joint.

Prevalence

Shoulder impingement syndrome is a very common cause of shoulder pain, accounting for 44% to 65% of all shoulder complaints. It is estimated that 7% to 34% of people experience shoulder complaints, with shoulder impingement syndrome as the underlying etiology.

References

• [1] Shoulder impingement happens when the top outer edge of your shoulder blade (scapula) pinches your rotator cuff beneath it.
• [2-3] This can result in pain, weakness, and loss of movement at the shoulder.
• [4] The estimated prevalence of shoulder complaints is 7% to 34%, often with shoulder impingement syndrome as the underlying etiology.
• [5] Shoulder impingement is a very common cause of shoulder pain, where a tendon (band of tissue) inside your shoulder rubs or catches on nearby tissue and bone.

Shoulder impingement syndrome (SIS) is characterized by several signs and symptoms that can indicate its presence. Here are some common ones:

• Pain in the top and outer side of your shoulder: This is one of the most common symptoms of SIS, often described as a dull ache or sharp pain [6].
• Pain when lifting your arm: Lifting your arm above your head or reaching backward can exacerbate the pain, making it difficult to perform everyday tasks [5], [8].
• Decreased range of motion: As the condition progresses, you may experience limited mobility in your shoulder joint, making it hard to move your arm freely [5].
• Pain radiating down your arm: In some cases, the pain from SIS can radiate down your arm, making it uncomfortable to hold or lift objects [9].
• Minor but consistent pain: Some people may experience a persistent, low-grade pain in their shoulder that doesn't go away even when they're not actively using their arm [10].
• Weakness: As the rotator cuff tendons become inflamed and irritated, you may feel weakness or fatigue in your shoulder muscles [9].

It's essential to note that these symptoms can vary from person to person, and some individuals may experience additional symptoms not listed here. If you're experiencing any of these signs and symptoms, it's crucial to consult with a healthcare professional for proper diagnosis and treatment.

References: [5] - Context result 5 [6] - Context result 6 [8] - Context result 8 [9] - Context result 9 [10] - Context result 10

Shoulder impingement syndrome, also known as subacromial impingement syndrome, is a clinical condition characterized by pain and inflammation in the shoulder joint due to compression or pinching of soft tissues between the acromion and the humerus. Diagnosing this condition can be challenging, but several diagnostic tests have been developed to help identify it.

Useful Diagnostic Tests

According to recent studies [1], five tests are useful for diagnosing subacromial impingement syndrome:

• Hawkins-Kennedy test
• Neer’s test
• Empty can test
• Speed's test
• O'Brien's test

These tests assess the range of motion and stability of the shoulder joint, as well as the presence of pain or tenderness in specific areas.

Specific Tests for Impingement Syndrome

Three of these tests (Hawkins-Kennedy, Neer’s, empty can) are particularly useful for ruling out subacromial impingement syndrome [2]. These tests involve specific movements and maneuvers that can help identify the presence or absence of impingement.

• The Hawkins-Kennedy test involves flexion, internal rotation, and adduction of the shoulder joint.
• Neer’s test involves abduction and external rotation of the shoulder joint.
• The empty can test involves flexion, internal rotation, and adduction of the shoulder joint with the arm in a position of 90 degrees of abduction.

Additional Diagnostic Tools

In addition to these physical examination tests, diagnostic imaging studies such as MRI (Magnetic Resonance Imaging) can be used to confirm the diagnosis of subacromial impingement syndrome [3]. These studies can help identify specific soft tissue injuries or abnormalities that may be contributing to the symptoms.

Algorithm for Management

A proposed algorithm for the management of subacromial impingement syndrome includes indications for nonoperative management, advanced imaging studies, and surgical intervention [4]. This approach takes into account the results of physical examination tests and diagnostic imaging studies to guide treatment decisions.

In summary, several diagnostic tests are useful for diagnosing shoulder impingement syndrome, including the Hawkins-Kennedy test, Neer’s test, empty can test, Speed's test, and O'Brien's test. These tests can help identify the presence or absence of impingement and guide further management decisions.

References:

[1] Context 12 [2] Context 13 [3] Context 14 [4] Context 13

Shoulder impingement syndrome can be challenging to treat, but various treatment options are available. While physical therapy plays a significant role in recovery (13), drug treatment is also an essential part of managing the condition.

Medications for Shoulder Impingement Syndrome

The primary goal of medication in treating shoulder impingement syndrome is to alleviate pain and inflammation. The following medications may be prescribed:

• Pain relievers: Over-the-counter pain medications such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can help manage mild to moderate pain.
• Corticosteroids: These powerful anti-inflammatory medications can be injected directly into the affected area to reduce swelling and relieve pain. However, their use should be limited due to potential side effects.
• Muscle relaxants: Medications like cyclobenzaprine (Flexeril) or carisoprodol (Soma) may be prescribed to help manage muscle spasms associated with shoulder impingement syndrome.

Important Consideration

It's essential to note that medication alone is often not sufficient to treat shoulder impingement syndrome. A comprehensive treatment plan, including physical therapy and lifestyle modifications, is usually necessary for effective management of the condition (13).

Surgical Treatment

In some cases, surgical intervention may be necessary to address underlying causes of shoulder impingement syndrome, such as bone spurs or muscle imbalances. However, this should only be considered after a thorough evaluation by an orthopedic specialist and a comprehensive treatment plan has been implemented.

References:

[1] - The estimated prevalence of shoulder complaints is 7% to 34%, often with shoulder impingement syndrome as the underlying etiology. [13] - Physical therapy is a major part of recovery from shoulder impingement.

Shoulder impingement syndrome, also known as subacromial impingement syndrome (SIS), is a clinical condition that can be challenging to diagnose due to its overlapping symptoms with other musculoskeletal disorders. The differential diagnosis for shoulder impingement syndrome includes:

• Rotator cuff tendinosis and partial tears: These conditions involve degeneration or tearing of the rotator cuff tendons, which can cause pain and weakness in the shoulder.
• Subacromial bursitis: Inflammation of the subacromial bursa, a fluid-filled sac that cushions the rotator cuff tendons from the acromion bone, can lead to pain and stiffness in the shoulder.
• Rotator cuff tears: Full-thickness tears of the rotator cuff tendons can cause significant pain and weakness in the shoulder.
• Shoulder instability: Conditions such as shoulder dislocation or subluxation can mimic the symptoms of shoulder impingement syndrome.
• Cervical spine pathology: Pain and dysfunction in the cervical spine (neck) can radiate to the shoulder, making it difficult to diagnose shoulder impingement syndrome.

To accurately diagnose shoulder impingement syndrome, a thorough clinical history and physical examination are essential. Imaging studies such as X-rays, ultrasound, or MRI may also be necessary to rule out other conditions and confirm the diagnosis [10][11][12].

It's worth noting that the diagnostic sensitivity of physical examination is 90% (e9), indicating that a careful and complete history and physical examination can accurately diagnose shoulder impingement syndrome in most cases [4].