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impingement syndrome |
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| Patient
Education Page
SHOULDER TOPICS *These pages are for informational purposes only and are not intended as medical advice. Please consult a physician for specific diagnosis and treatment options* |
The shoulder is one of the most
complex joints in the body. It's intricate design allows for great
movement and flexibility but not much stability. When all of the
parts of the shoulder are working properly it can move freely and without
pain. A traumatic injury, general "wear and tear" or
overuse of the shoulder can create shoulder problems.
Shoulder impingement or impingement syndrome occurs when the space between the acromion and rotator cuff has diminished. People in sports or job related activities that require frequent raising of the arm are subject to shoulder impingement. The bursa located between the acromion and rotator cuff provides a cushion between these two areas and permits smooth movement when you raise your arm. Excessive use of the shoulder can cause the bursa to "pinch off" or impinge causing inflammation of the bursa, or bursitis. Arthritic changes may occur on the acromion or at the AC joint and bony spurs may develop. These bony spurs can also lead to the development of impingement syndrome. Because there is less room to move between the acromion and the rotator cuff, friction occurs on the rotator cuff and can lead to rotator cuff tears. SYMPTOMS Patients find it painful to raise their arm and may feel grinding when doing so. They can experience pain at night. Weakness when raising the arm, or inability to raise the arm can be a sign of a rotator cuff tear. DIAGNOSIS The physical exam helps to determine the motion, weakness and any instability in the shoulder. Understanding your symptoms is an important part in diagnosing your problem. An xray may be taken to determine if there is any problems with the bones in your shoulder such as arthritis or fractures. If a rotator cuff tear is suspected, an MRI may be ordered to visualize the location of the tear. Another test that can help to determine if there is a rotator cuff tear is an arthrogram. This involves injecting a dye into the shoulder joint and taking a series of xrays. If the dye is detected outside of the shoulder joint, it could indicate a rotator cuff tear among other things. TREATMENT Impingement syndrome can often be treated conservatively by resting the arm and taking anti-inflammatory medication to reduce the inflammation. Some exercises or physical therapy may be prescribed to strengthen the rotator cuff muscles to maintain shoulder mobility. A steroid injection may be used as your physician deems necessary. If conservative treatment options are not effective, or if the patient has a rotator cuff tear in addition to the shoulder impingement, surgical intervention is typically required. The purpose of surgery for impingement syndrome is to increase the space between the acromion and rotator cuff. This includes smoothing over the bottom surface of the acromion and removing any bone spurs that may be there or are found at the AC joint. Removing the inflamed bursa is also an important aspect of the treatment. If the rotator cuff is torn, it is repaired. When the rotator cuff tears, it usually comes unattached from the humerus. The rotator cuff is reattached to the humerus using suture and occasionally special anchors which hold it in place. The surgery can be done arthroscopically or can be done through a small open incision. Which method is used is dependent on the severity of the injury and doctor preference. |