Shoulder impingement: The “nagging” shoulder pain
Dr Zulfikar Bux, Features / Columnists
By Dr. Zulfikar Bux
Assistant Professor of Emergency Medicine
Kaieteur News – Shoulder impingement is a very common cause of shoulder pain, where a tendon inside your shoulder rubs or catches on nearby tissue and bone as you lift your arm. It affects the rotator cuff tendon, which is the rubbery tissue that connects the muscles around your shoulder joint to the top of your arm.
An impinging shoulder will often improve in a few weeks or months, especially with the right type of shoulder exercises, but occasionally it can be an ongoing problem leading to a persistently painful shoulder joint.
Today we will discuss this very common cause of persistent shoulder pain.
WHAT ARE SYMPTOMS OF SHOULDER IMPINGEMENT?
Shoulder impingement can start suddenly or come on gradually.
Symptoms include:
• pain in the top and outer side of your shoulder
• pain that’s worse when you lift your arm, especially when you lift it above your head
• pain or aching at night, which can affect your sleep
• weakness in your arm
• Your shoulder will not usually be stiff. If it is, you might have a frozen shoulder instead.
WHAT CAUSES SHOULDER IMPINGEMENT?
When you lift your arm, the rotator cuff tendon passes through a narrow space at the top of your shoulder, known as the subacromial space. Shoulder impingement occurs when the tendon rubs or catches on the bone at the top of this space, called the acromion.
This can happen if:
• the tendon becomes swollen, thickened or torn – this can be due to an injury, overuse of the shoulder or “wear and tear” with age
• the fluid-filled sac (bursa) found between the tendon and acromion becomes irritated and inflamed (bursitis) – this can also be caused by an injury or overuse of the shoulder
• the acromion is curved or hooked, rather than flat – this tends to be something you’re born with
• there are bony growths called spur on the acromion – these can develop as you get older
WHEN SHOULD YOU SEE A DOCTOR?
See a doctor if you have shoulder pain that does not go away after a few weeks or is stopping you from doing your normal activities. He/she will look at your shoulder and ask you to move your arm in different ways to see how easily you can move it and if movement makes the pain worse.
The doctor may suggest some treatments you can try or refer you to a physiotherapist for treatment advice. You probably will not need to go to hospital for any scans.
WHAT CAN YOU DO TO HELP IF YOU HAVE SHOULDER IMPINGEMENT?
• Avoid things that make the pain worse – avoid activities that involve repeatedly lifting your arm above your head for a few days or weeks. Ask your doctor when you can restart these activities.
• Do not stop moving your arm completely – try to carry on with your normal daily activities as much as possible so your shoulder does not become weak or stiff. It’s usually best to avoid using a sling.
• Hold an ice pack to your shoulder for around 20 minutes several times a day
• Take painkillers – anti-inflammatory painkillers such as ibuprofen or paracetamol may help. A doctor can prescribe stronger painkillers if needed.
HOW IS SHOULDER IMPINGEMENT TREATED?
Your doctor will put you on a course of anti-inflammatory painkillers and review you in a week or two. If it doesn’t improve, the following may be other treatment options that your doctor will explore with you:
• Shoulder exercises – A doctor may be able to advise you about simple shoulder exercises you can do. Physiotherapists can also diagnose shoulder impingement and suggest exercises to help improve shoulder posture and further strengthen your muscles to improve your pain and range of movement. You may need to do these exercises with a physiotherapist at first, but after a while you’ll usually be able to continue doing them at home.
• Steroid Injections – Steroid injections into your shoulder can help relieve pain if rest and exercises on their own do not help. But it’s still important to do your shoulder exercises, as injections usually only have an effect for a few weeks and your pain may come back if you stop the exercises. While the injection can be repeated if needed, having more than 2 is not usually recommended because it might damage the tendon in your shoulder in the long term.
• Surgery-A surgery called a subacromial decompression may be an option if other treatments have not worked, although there’s some uncertainty about how much it helps. The surgery involves widening the space around the rotator cuff tendon so it does not rub or catch on anything nearby.
The pains from shoulder impingement can often be relieved, especially if caught early. Do not hesitate to visit your doctor if you this type of nagging shoulder pains.
