Shoulder impingement occurs when the rotator cuff rubs or catches on the under surface of the acromion, which is the bone over the top of the shoulder. This most commonly occurs during elevation of the arm and the patient may experience pain whilst working with the arms above shoulder height. Patients often report difficulty tasks such as reaching top shelves, washing their hair or hanging clothes on the clothes line.
Shoulder impingement is often associated with inflammation in the space between the rotator cuff and the acromion. This space is called a bursa and it normally contains lubrication fluid to reduce friction between the shoulder and the acromion. Inflammation in the bursa is known as bursitis, and this causes an unrelenting shoulder pain that often doesn’t respond to pain medication. Patient’s tend to notice the pain more at night and it may interfere with normal sleep patterns, either by preventing the patient from falling to sleep, waking the patient during the night or preventing the patient from sleeping the affected side.
How Is It Diagnosed?
Clinical examination can often identify shoulder impingement and bursitis, however, in severe cases it is often difficult to distinguish impingement from a rotator cuff tear or an early frozen shoulder when all movement of the shoulder reproduce pain. In this circumstance it may be necessary to order further tests to diagnose the problem. Shoulder impingement and bursitis can usually be seen on an ultrasound and it is also readily visible on an MRI scan. Shoulder impingement and bursitis cannot be seen on an x-ray, although an x-ray is often performed to exclude other diagnoses, such as arthritis. For cases where there multiple pathologies are present, such as neck problems or frozen shoulder, it can be difficult to determine how much pain is coming from the bursa and how much is coming from the other source. An injection of local anaesthetic and cortisone can help distinguish the source of pain.
Other Common Conditions Associated With Impingement and Bursitis:
Rotator Cuff tendinosis
Bursal sided partial thickness rotator cuff tears (scuffing of the tendon)
AC Joint arthritis.
How Is It Treated?
There are several treatment options available for the treatment of impingement. They include:
Injections of cortisone and local anaesthetic into the bursa, usually done under ultrasound guidance.
Arthroscopic surgery for an acromioplasty.
The best treatment will be determined by a number of factors, including your age, the duration and severity of your symptoms, and the presence of other pathologies.
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