Subacromial Impingement

Shoulder Conditions

What is shoulder impingement?

Impingement is the rubbing, catching or pinching of the rotator cuff tendons between structures within the shoulder. With internal impingement this occurs when the undersurface of the rotator cuff tendons rub between the superior and posterior labrum (the cartilaginous rim that deepens the glenoid socket) and the humeral head. Classically this occurs with full abduction and external rotation such as when about to throw.

 

Who gets impingement and what are the symptoms?

The microtrauma from repetitive throwing causes what is called a “kissing lesion” whereby scuffing or tears are seen on the undersurface of the labrum and the labrum. It is typically seen in overhead throwing athletes but also in swimmers. Patients present with pain worse with throwing deep within the shoulder and often in the back of the shoulder.

 

How is impingement diagnosed?

A thorough clinical history and physical examination will confirm the diagnosis. An ultrasound allows for a dynamic assessment of the rotator cuff tendons but an MRI scan particularly with dye (MR Arthrogram) gives a detailed evaluation of the labrum and posterosuperior labral tears.

 

How is impingement treated?

Painkillers (analgesia) and anti-inflammatories are important in managing the initial symptoms. Rest and avoiding overhead activities for a period is essential in allowing the inflammatory cycle to settle.

A cortisone injection into the joint will help reduce the inflammation and pain arising from the undersurface scuffing or tear of the rotator cuff tendon.

Physiotherapy plays an essential role in managing internal impingement by strengthening of the rotator cuff muscles but also sports specific training aimed at improving throwing technique, improving shoulder blade positioning and correcting posture.

Surgery may be required if symptoms persist. This is often performed arthroscopically and if present and tears to the labrum or rotator cuff tendons can be repaired at the same time. Occasionally in individuals who have mal-aligned joints further corrective open surgery may be required to realign the joint.

As surgical techniques have improved significantly over the last decade, complications are reduced and recovery much quicker than in the past.

Following surgery, a rehabilitation program with physiotherapy is commenced to help you return to your normal day to day activities. The progress of this is dictated by patients meeting milestones and is run under the supervision of the surgeon and specially trained physiotherapist.

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