Bursitis – Impingement Syndrome
“Shoulder impingement syndrome, also called subacromial impingement, painful arc syndrome, supraspinatus syndrome, swimmer’s shoulder, and thrower’s shoulder, is a clinical syndrome which occurs when the tendons of the rotator cuff muscles become irritated and inflamed as they pass through the subacromial space, the passage beneath the acromion. This can result in pain, weakness and loss of movement at the shoulder.” In Wikipedia.
What is Bursitis – Impingement Syndrome?
Impingement syndrome is a fancy word for “pinching” of the rotator cuff muscles in the shoulder. The muscles get pinched between two bones (the humeral head and the acromion process) and this causes inflammation. Inflammation will lead to more pinching and that is when you get pain. There is a small protective sack in the shoulder that is on top of the rotator cuff tendon. This is the bursa for the shoulder. When one gets inflammation in the tendon we refer to this as impingement, bursitis of the shoulder or rotator cuff tendonitis.
The pain is usually felt on the outside of the shoulder or arm area and can radiate to the elbow or into the neck. I usually see impingement in patients over the age of 30 and very rarely in the younger patient. Anyone can get it – from sedentary patients to athletes. Reaching overhead or use of the arm in certain directions makes the pain worse. Popping or snapping in the shoulder may be felt with movement. As the impingement syndrome progresses the rotator cuff muscles weaken and may subsequently tear. This is one of the ways you can tear the rotator cuff muscles.
What are the causes of impingement or bursitis?
There are multiple causes, but the most common is a small bone spur or a tight ligament. These structures are usually the culprits for all of your pain. They are the ones which cause the inflammation in the rotator cuff and/or bursa. For something so small they can sure cause a lot of sleepless nights and overall discomfort.
What can you do about impingement or bursitis of the shoulder?
Since a majority of the patients with impingement get better with conservative management, this is my initial approach to your painful shoulder. This consists of physical therapy, oral anti-inflammatory medicine and/or the use of a local anti-inflammatory injection into the shoulder. My goal is to decrease the swelling or inflammation in the rotator cuff so that it will not get “pinched”. With less inflammation, you will have less pain. As the inflammation decreases, you will also have less damage to your rotator cuff tendons.
For a minority of patients, surgery will need to be performed to remove the offending agent (typically a bone spur) and take the pressure off of the rotator cuff. This procedure is done with an arthroscope through small incisions. An arthroscope is a small camera we use to view into small spaces. The surgery is done as same day procedure. Please section on shoulder surgery in the website.
What can I expect from treatment?
Every person is different and it is imperative to get the proper diagnosis so that you can start on the appropriate therapy, medicine and/or have the correct surgical procedure. The results are excellent in a great majority of the patients. Underlying medical conditions can increase the likelihood of complications we may encounter along the way.