Three bones make up the shoulder, the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle). The joint is covered with the rotator cuff muscles and tendons that attach the upper arm bone to the shoulder blade and holds the upper arm bone in its socket. There is also a sack of lubricating fluid, called the bursa, provides lubricating fluid for smooth movement of the rotator cuff.
Shoulder impingement is a common cause of shoulder pain that makes it difficult to move your arm to perform the ordinary activities of daily life and can interfere with sleep. Impingement occurs when the acromion (the top of the shoulder blade) rubs against and pinches the cuff beneath it.
The rotator cuff is a group of four muscles and their tendons that sit between the humerus, the head of the upper arm bone, and the top of the shoulder blade. Overuse of the rotator cuff muscles and tendons causes them to swell which narrows the space between the bones and pinches cuff tendons. Pinching decreases blood flow which leads to fraying of the rotator cuff tendons.
The condition is seen most often in people who swim regularly or play tennis or participate in throwing sports like baseball. It can also occur in people who perform a lot of overhead motions such as painting or reaching for items on high shelves.
Other causes include:
- Bone spurs caused by friction or arthritis can narrow the joint space and cause impingement.
- An injury like a fall on an outstretched arm can cause impingement.
- An inflamed and swollen bursa caused by overuse.
- An unstable shoulder can dislocate and cause impingement.
- Poor posture and age can contribute to development of shoulder impingement
The main symptom is pain in the shoulder with overhead activities. The pain may be sharp or dull and can radiate from the shoulder to the side of the neck or down the arm.
Other symptoms include:
- pain at night
- arm weakness
- limited range of motion
- a popping or cracking sensation when the shoulder is moved
Dr. Patel will review your medical history including when and under what conditions you experience shoulder pain and other symptoms. He will conduct a thorough physical exam checking for pain and tenderness. He will evaluate your shoulder range of motion, and perform specific tests to identify damage to the rotator cuff. He will order x-rays to view the bones and identify shoulder arthritis and bone spurs, and an MRI to view the rotator cuff tendons and inflammation.
The goal of treatment is to restore pain free function. Shoulder impingement is commonly treated with rest, icing, and over-the-counter pain relievers, physical therapy, and steroid injections to reduce inflammation and pain. Nonsurgical treatment should improve the shoulder pain and function in several weeks.
Surgery is rarely needed. If needed, surgery comprises the release of the trapped tissues and repair of rotator cuff damage. The procedure is called an arthroscopic shoulder decompression during which the space for the rotator cuff is enlarged by shaving the bone and removing soft tissues to open the space for the rotator cuff tendons. After surgery you will wear a sling to support the shoulder during healing, followed by rehabilitation to restore range of motion and strength. Recovery can take 2- 4 months.
Dr. Ronak M. Patel is a double board-certified orthopaedic surgeon and sports medicine physician. He completed his bachelor’s degree, medical degree, and residency training at Northwestern University. He, then completed his fellowship training at the Cleveland Clinic. He specializes in the treatment of complex knee, shoulder and elbow injuries and degenerative conditions. Contact him to schedule a consultation to learn more about how he can help you return to the life you love and the activities that make life worth living. He serves teens and adults in Chicagoland and NW Indiana.
At a Glance
Ronak M. Patel M.D.
- Double Board-Certified, Fellowship-Trained Orthopaedic Surgeon
- Past Team Physician to the Cavaliers (NBA), Browns (NFL) and Guardians (MLB)
- Published over 49 publications and 10 book chapters
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