IMPINGEMENT SYNDROME

Shoulder impingement occurs when the rotator cuff and the sub-acromial bursa are pinched due to narrowing of the sub-acromial space. This repetitive pinching leads to inflammation of the rotator cuff tendon (tendinitis) and the sub-acromial bursa (bursitis), resulting in thickening of these tissues and further constriction of the sub-acromial space. The pinching action typically occurs during shoulder movements, especially when lifting the shoulder upwards, outwards, and forwards, such as during overhead activities. This leads to symptoms like shoulder pain, weakness, and limited mobility. The causes of shoulder impingement may include: Rotator cuff injuries, such as tears or strains, which can cause swelling of the tendon, making it more susceptible to catching on the underside of the acromion. Development of a bony spur on the underside of the acromion, commonly associated with the aging process, which can irritate the rotator cuff and the sub-acromial bursa. Arthritis of the Acromio-Clavicular (AC) joint, which can lead to the formation of spurs on the joint's underside, contributing to impingement. Inflammation of the sub-acromial or sub-coracoid bursa (bursitis), fluid-filled sacs within the shoulder, which can become swollen and inflamed, causing them to be pinched against the underside of the acromion or coracoid, resulting in shoulder pain and weakness, particularly during overhead activities.

Sub-acromial impingement presents with distinctive symptoms, notably shoulder pain concentrated in the front and outer side of the upper arm, particularly aggravated by overhead activities. This discomfort often disrupts sleep, making it challenging to rest comfortably on the affected shoulder. Additionally, individuals may experience sensations of grinding or catching when moving the shoulder, especially during movements that involve raising it overhead. These symptoms collectively signify the impingement of tissues within the sub-acromial space, prompting individuals to seek evaluation and treatment for relief.

Diagnosing shoulder impingement involves a comprehensive approach comprising medical history assessment and thorough clinical examination. During the examination, healthcare providers meticulously note the patient's medical history and conduct a detailed assessment. This involves identifying areas of tenderness, reproducing pain through specific provocative maneuvers, evaluating muscle strength, and assessing shoulder mobility for any restrictions. By carefully examining these factors, clinicians can effectively diagnose shoulder impingement and formulate an appropriate treatment plan tailored to the individual's needs.

Treatment for shoulder impingement can be non-surgical or surgical, depending on the severity and response to initial interventions. Conservative (Non-Surgical) Treatment: For the majority of patients, the initial approach is conservative, involving a combination of rest, avoiding overhead activities, and taking painkillers and anti-inflammatory medications as needed. Additionally, undergoing physiotherapy helps control pain, reduce tendon inflammation, and improve shoulder function over a period of 3 to 4 months. If pain persists despite these measures, a steroid injection into the subacromial space may be considered. Surgical Treatment - Arthroscopic Subacromial Decompression (ASD): If non-surgical methods fail to alleviate symptoms over 3 to 6 months or if symptoms worsen during conservative treatment, arthroscopic surgery may be recommended. During this procedure, known as Arthroscopic Subacromial Decompression (ASD), the joint interior and the under-surface of the rotator cuff are examined. Any thickened soft tissues or bony spurs causing impingement are identified and removed using specialized instruments. This includes removing the inflamed subacromial bursa (subacromial bursectomy) and trimming the coracoclavicular ligament or acromial bony spurs (sub-acromial decompression). If the rotator cuff tendon shows inflammation or fraying, it is debrided to prevent further irritation. Any identified tendon tears are assessed and either debrided or repaired accordingly. The goal of subacromial decompression surgery is to create more space in the subacromial region, relieving pain, restoring frictionless movement of the rotator cuff, and improving overall shoulder mobility and function.