Impingement

Impingement syndrome is when the rotator cuff tendons (supraspinatus, infraspinatus, teres minor, and subscapularis) become trapped in the shoulder joint. Repeated impingement can lead to inflammation and thickening, which in turn will result in more impingement and trapping of the inflamed tendons. The original cause can be overuse or one traumatic incident such as a fall. This is a common condition in swimmers and throwers as well as racket players or any athlete who has to make repeated movements with arms above shoulders.

Shoulder impingement syndrome can be divided into two categories, bursitis, and tendonitis, which can occur independently or together.

1. Bursitis

The bursa is the lubricating sac located above the rotator cuff. Inflammation of the bursa results in mild to severe pain with limited movement. The initial treatment for bursitis is rest. If necessary, icepacks can also be prescribed, as well as anti-inflammatory drugs, steroid injections, and ultrasound therapy. Some patients require temporary use of a sling. After inflammation subsides, the patient should do shoulder strengthening exercises. If conservative treatment fails, surgery may be required.

2. Tendonitis

Inflammation of the rotator cuff tendons specifically results in tendonitis, in which the patient is unable to maintain specific arm positions. Acute tendonitis will go away on it own if the activity that caused the insult is discontinued. After the inflammation is gone the patient can gradually resume the activity in which heat, stretching, and ice is added into the routine. More severe cases may require anti-inflammatory drugs or a cortisone injection. Again, as with bursitis, surgery may be required but only after all other causes have been ruled out.

Shoulder pain should not be ignored. Working through the pain with activities, like tennis or golf may worsen the problem. Instead, shoulder pain should be addressed with your physician, especially if pain worsens with activity. However, the first method for treating a painful shoulder should always be rest first.