Impingement syndrome (trapped shoulder tendon)
Impingement syndrome, or trapped shoulder tendon, is a condition that generally affects people from middle-age and onwards, and those active in sport.
Impingement syndrome is associated with rotator cuff tendonitis and shoulder bursitis. These medical conditions can occur on their own or at the same time.
When an injury occurs to the rotator cuff muscles and tendons, which encase the shoulder joint, they respond by swelling. However because these are surrounded by bone, when they swell a series of other events occur.
Movements such as reaching up behind the back or reaching up overhead - for example to put on a coat or shirt - may cause pain as the swollen muscle and tendon rubs on bone.
What are the symptoms of shoulder impingement syndrome?
The typical symptoms of impingement syndrome include difficulty reaching up behind the back, pain with overhead use of the arm and weakness of shoulder muscles.
If these muscles are injured for a long period of time, the muscle can actually tear in two, resulting in a rotator cuff tear. This causes significant weakness and may make it difficult for the person to raise his or her arm. Some people will have rupture of their biceps muscle as part of this continuing impingement process.
How is impingement syndrome diagnosed?
Diagnosis begins with a medical history and physical examination by your doctor. X-rays will usually be taken to rule out arthritis and may show changes in the bone that indicate injury of the muscle. Bone spurs or changes in the normal contour of the bone may be present. Impingement syndrome may be confirmed if an injection of a small amount of an anaesthetic into the space under one of the shoulder bones relieves pain.
How is shoulder impingement syndrome treated?
Oral anti-inflammatory medications such as aspirin, naproxen or ibuprofen remain the most common treatment for this condition.
Taking anti-inflammatory medications for a short period of time may treat the symptom of pain, but it will not treat the underlying problem and symptoms will come back. There is no specific medication for this condition and response to any given medication differs from person to person.
In addition to taking medications daily stretching in a warm shower will help. Work to reach your thumb up and behind your back. Avoid repetitive activities with your injured arm, particularly where the elbow would move above shoulder level. Avoid vacuuming, painting, raking leaves and washing the car. Your doctor may refer you to a physiotherapist, who can demonstrate the exercises most effective in strengthening and stretching the shoulder muscles.
If you have persistent symptoms, despite the use of oral anti-inflammatory medications, your doctor may consider a corticosteroid injection. This uses a potent anti-inflammatory medication, which should be used only when necessary because it can result in weakening of muscles and tendons.
The vast majority of people who have impingement syndrome are successfully treated with medication, stretching exercises and temporary avoidance of repetitive overhead activity until the condition settles down.