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Shoulder impingement
What is impingement syndrome?
Impingement syndrome is characterised by pain and sometimes weakness when you raise your arm, caused by a muscle tendon getting trapped in your shoulder.
It involves the rotator cuff tendon which runs through a narrow space between the top of your arm bone and the shoulder blade. The rotator cuff tendon attaches your shoulder blade to the top of your arm bone.
In impingement syndrome, the tendon becomes trapped in this space and is repeatedly pinched underneath the bony roof of the shoulder, causing pain when you lift your arm up.
It may start suddenly after an injury, or gradually without any obvious cause.
How do we treat impingement syndrome at the Mansfield Clinic?
Impingement syndrome is usually treated with a combination of osteopathic mobilisation, a specific exercise programme to keep the shoulder muscles strong, and occasionally a corticosteroid injection to reduce the swelling and inflammation that builds up around the rotator cuff tendons.
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Impingement syndrome
What is the cause?
The space through which the rotator cuff tendon passes is quite tight, especially when the arm is elevated above the horizontal. Any condition that narrows this space even more can cause impingement of the tendon. This can include:
- bony outgrowths forming around the roof of the shoulder which encroach onto the space where the rotator cuff tendons are
- calcium deposits that build up within the rotator cuff tendons
- poor shoulder blade posture and muscle control
How is it diagnosed?
Dr Allfree will usually be able to diagnose impingement syndrome by talking to you and by examining your shoulder.
You may be asked to raise your arm to the side slowly to see if this provokes pain as the rotator cuff tendon gets pinched under the roof of the shoulder.
If the diagnosis isn't clear you may need further investigations, such as an x-ray or an MRI scan, You may also be referred for a specialist assessment from a shoulder surgeon.
How is it treated?
If impingement syndrome is only mild then it may settle down simply with rest, ice packs and anti-inflammatory tablets. Ice packs are available from the Mansfield Clinic.
While it is important to rest the shoulder joint, you should not stop moving it altogether, otherwise you will develop weakness in the muscles, and you may develop stiffness in the shoulder. Dr Allfree may recommend some simple osteopathic mobilisation techniques, combined with an exercise programme, to keep your shoulder moving.
If there is significant inflammation, Dr Allfree may recommend an injection of corticosteroids into the affected area of the shoulder. Possible side effects include thinning and lightening of the skin.
Although corticosteroid injections can relieve pain, without mobilisation they do not have a long-term effect and it is common for the pain to return. You can sometimes have another injection, but you will need to wait at least six weeks.
Alternatively, you may need to have an operation to widen the space under the roof of your shoulder so the tendon is no longer rubbing against the bone. This is also done as a keyhole operation known as an arthroscopy. Dr Allfree will be able to help you with the arrangements if a surgical opinion is needed.