Subacromial impingement syndrome

The term ‘impingement’ is a sign and isn’t a diagnosis as such. Subacromial impingement syndrome can have several causes including a narrowing of the subacromial space, where the subacromial bursa and rotator cuff tendons sit in the ‘space’ under the acromion bone at the top of the shoulder, and inflammation associated with recent trauma or shoulder instability, especially in younger athletes.

In the under 35 year group, repeated movements in the overhead position can lead to the problems and there may also be tears in the cartilage, or labrum, that attaches to the socket side of the joint and makes the cup deeper for the ball – the head of the upper arm bone (humerus).

In the over 35s, the changes in the space tend to be more related to the aging process with some degeneration, that can eventually lead to rupture of the tendons in some cases. The pain will be felt on lifting the arm above the shoulder, as in putting plates into a cupboard or whilst putting on a coat, for example.

Impingement syndrome involves inflammation and swelling in the subacromial space that can develop into thickening and scarring, or fibrosis, of the tissues with tears in the rotator cuff tendons. Clinical tests can diagnose the condition which can be confirmed by ultrasound or MRI scanning techniques.

Physiotherapy can help by treating the individual tendons with a specific massage technique called ‘frictions’; mobilising and stretching the tissues at the shoulder, including tight muscles, and providing clear advice on exercises to improve strength, stability and shoulder and neck posture overall. Ice, electrotherapy or acupuncture can also be used to help with the pain. Education plays a key role in rehabilitation and preventing the condition from returning.

If the symptoms persist, an injection into the space can be helpful and a specialist referral may be the next step, especially if the shoulder becomes more weak than painful on certain movements, which could imply tendon rupture and the need for surgical repair.

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