Shoulder Impingement Syndrome

Shoulder impingement syndrome is a common cause of shoulder pain. It occurs when there is impingement of tendons or bursa in the shoulder, from the acromion bone of the shoulder.  Overhead activity of the shoulder, is a risk factor for shoulder impingement syndrome. Examples include: painting, swimming, tennis etc. With impingement syndrome, pain is persistent and affects everyday activities. Motions such as reaching up behind the back or reaching up overhead to put on a coat or blouse, for example, may cause pain.



Impingement Overhead

What Are the Symptoms of Shoulder Impingement Syndrome?
The typical symptoms of impingement syndrome include difficulty reaching up behind the back.

If tendons are injured for a long period of time, the tendon can actually tear in two, resulting in a rotator cuff tear. This causes significant weakness and may make it difficult for the person to elevate his or her arm.

The painful abduction arch

How Is Impingement Syndrome Diagnosed?
Diagnosis of impingement syndrome begins with a medical history and physical exam by your doctor. In X-Rays Bone spurs or changes in the normal contour of the bone may be present. If symptoms persist or if significant weakness is present, then your doctor may perform an ultrasound, MRI, or arthrogram to rule out a rotator cuff tear. If the cuff is torn, surgery may be necessary to repair it.

Bone spurs

How Is Shoulder Impingement Syndrome Treated?
Oral NSAID are the most common treatment for impingement syndrome.

Avoid repetitive activities with your injured arm, particularly activities where the elbow would move above shoulder level.
The physical therapist demonstrates exercises most effective in strengthening and stretching the shoulder muscles.


A cortisone injection is an alternative treatment . Cortisone is a potent anti-inflammatory medication, which should be used only when necessary because it can result in weakening of muscles and tendons if used repeatedly.

Cortisone injection

The vast majority of people who have impingement syndrome are successfully treated with medication, stretching exercises, strengthening of rotator cuff exercises and temporary avoidance of repetitive overhead activity until the condition settles down.

Cuff exercises

Shoulder impingement syndrome surgery (Acromioplasty)
Narrowness of the space below the acromion may cause wear and irritate the tendons that move the shoulder. As a result of the friction, the tendon becomes inflamed causing pain and aching even when not moved, and often movement limitations. If exercises do not produce the desired improvement, a decompression surgery of the acromion (acromioplasty) is performed.

The operation is usually performed using the arthroscopic surgery under regional anaesthesia and/or general anaesthesia. In the surgery, the anterior part of the acromion causing the compression is removed with a burr, leaving a smooth surface.

Osteophyte removed with a burr

The mobility of the joint should be normal 4–8 weeks after the surgery. The patient should start with the movement exercises of the shoulder joint immediately after the operation, as permitted by the pain, increasing the exercises gradually. If there is no tendon repair, there is no limit in joint mobilization.