Shoulder impingement syndrome | Rotator Cuff impingement syndrome
In new research, doctors in Germany wanted to make clear what shoulder impingement syndrome is and what their suggestions are for treatment:
Before you read on, if you have questions about Rotator Cuff Impingement Syndrome, you can get help and information from our Caring Medical staff
- In addition to tears of the rotator cuff, isolated impingement syndrome of the shoulder is the most common diagnosis in shoulder disorders and is of high relevance in orthopedic sports medicine.
- In fact, impingement of the shoulder is not the diagnosis but rather a symptom of a functional or even a structural shoulder damage. (Note: We call this shoulder instability, the excessive motion of the shoulder due to weakened and damaged ligaments, allows the soft tissue of the rotator cuff to be pinched, caught, or impinged upon by the bones of the shoulder).
- Detailed knowledge about the different types of impingement and the underlying causes is essential to provide adequate treatment.
- Primarily, impingement of the shoulder should be treated nonoperatively.
- However, if there is no clinical improve despite adequate conservative treatment, there is usually structural damage that cannot be adequately compensated for and surgical treatment may be necessary such as a full-thickness tear of the rotator cuff.1
As a side note, nonoperative treatment now includes a Nintendo Wii game console. Doctors at New York University say that as compared to conventional treatment, a structured Wii gaming protocol was a viable adjunct to therapy for shoulder impingement syndrome. Gaming may have a supplemental benefit by increasing motivation, pleasure, and/or adherence. 2
Nintendo Wii game notwithstanding, a team of German and Chinese researchers noted in the medical journal Medicine that there are many treatments for shoulder impingement syndrome. Some work, some did not work as well, some worked best when combined with exercise. They found:
- Combined treatments (such as acupuncture) and exercise tended to yield better effects than single-intervention therapies (such as exercise alone).
- Localized drug injections that were combined with exercise showed better treatment effects than any other treatments, whereas worse effects were observed when such injections were used alone. (Please see my article Alternatives to Cortisone).
- Low-level laser therapy and the localized injection of nonsteroidal anti-inflammatory drugs are not recommended.
The doctors concluded that for patients who have a long-term shoulder impingement syndrome , operative treatments may be considered, however, the choice of surgery should be made cautiously because similar outcomes may also be achieved by the implementation of exercise therapy.3
The Diagnosis of Impingement Syndrome
The shoulder joint is formed where three bones, the scapula (shoulder blade), the humerus (upper arm bone), and the clavicle (collarbone) meet. The scapula and the clavicle meet to form the top or roof of the shoulder and is called the acromion. The joint where the acromion and the clavicle join is the Acromioclavicular joint or AC joint.
Patients who have been to the doctor for shoulder pain and have been told that they have impingement syndrome, report that their scans are saying the rotator cuff tendon has become pinched between the humeral head, on which it is attached, and the overhanging acromion process, when the arm is raised above the head. This happens when the space becomes narrowed, as occurs when the rotator cuff muscles weaken and the humeral head rides high in the socket or when bone spurs and calcium deposits narrow the space.
Some may have been told that they have a swollen rotator cuff tendon or bursa, which is being painfully squeezed between the humeral head and the acromion process.
Diagnosis of impingement syndrome should begin with a medical history and physical exam by the physician. Radiographs are often taken to look for or rule out arthritis, bone spurs, or bony changes.
Impingement syndrome is one of several shoulder conditions that can cause inflammation of the bursa or the tendons within the joints in the shoulders, such as bursitis or rotator cuff tendonitis. These conditions may occur alone or in combination. Impingement syndrome is a common shoulder condition affecting older adults. Individuals with impingement syndrome often have a bony spur on the clavicle that limits the space through which the supraspinatus tendon can travel.
A Prolotherapist’s Approach to Impingement Syndrome
We feel that someone suffering from impingement syndrome should seek a consultation with a Prolotherapist before jumping into rotator cuff surgery. In many cases, the preferred treatment method can be more conservative. In our office, we stimulate the soft tissue of the shoulder to repair with Prolotherapy injections to the ligaments and tendinous insertions of the rotator cuff and deltoid. Prolotherapy, in combination with gradual re-strengthening of the rotator cuff muscles, gives an excellent chance for a full recovery.
Often times the impingement syndrome is due to overgrowth of bone in the acromioclavicular joint, a bone spur, is pinching on the rotator cuff tendon. Instability of the acromioclavicular joint from ligament injury causes this overgrowth of bone. Prolotherapy to the soft tissues of the acromioclavicular ligament can stabilize that joint.
Prolotherapy gets rid of the impingement by stabilizing the acromioclavicular (smaller shoulder joint) or the glenohumeral joint (larger shoulder joint). The excessive motion that was pinching the tendon no longer occurs, because the joint is stabilized. The excessive motion is gone, the pinching and symptoms are gone, and over time the bone spur will be reabsorbed by the body.
Impingement syndrome of the shoulder may respond well to arthroscopic surgery, however, to eliminate unnecessary surgeries, we encourage Prolotherapy treatment of the shoulder. If there is a rotator cuff tear that has become large enough to produce profound weakness in the shoulder, then shoulder surgery may be necessary. Prolotherapy can still be used as a post-operative treatment to improve tissue strength and overall recovery.
If you have questions about Rotator Cuff Impingement Syndrome, you can get help and information from our Caring Medical staff
1 Beirer M, Imhoff AB, Braun S. Impingement syndromes of the shoulder. Orthopade. 2017 Apr;46(4):373-386.
2 Rizzo JR, Thai P, Li EJ, Tung T, Hudson TE, Herrera J, Raghavan P. Structured Wii protocol for rehabilitation of shoulder impingement syndrome: A pilot study. Ann Phys Rehabil Med. 2017 Mar 15. pii: S1877-0657(16)30516-4.
3. Dong W, Goost H, Lin XB, Burger C, Paul C, Wang ZL, Zhang TY, Jiang ZC, Welle K, Kabir K. Treatments for Shoulder Impingement Syndrome: A PRISMA Systematic Review and Network Meta-Analysis. Medicine (Baltimore). 2015 Mar;94(10):e510. [Pubmed]