To the rotator cuff muscles compressing against the structures forming the upper portion of the shoulder. The region is referred to as the subacromial space and includes the acromio-clavicular joint, coraco-acromial ligament and the acromion (outer edge of the scapula or shoulder blade). This narrowing of the space that the rotator cuff muscle tendons pass through causes the muscles to become irritated and inflamed, resulting in pain, weakness and in severe cases, the loss of mobility.
One crucial aspect of the rotator cuff muscles daily functions is to act as a depressor of the humeral head. This in turn contributes to keeping the humeral head and shoulder stable. The rotator cuff muscles also assist in actively raising the arm overhead (flexion and abduction) and turning the arm in and out (internal and external rotation).
A mechanical dysfunction is said to occur when the rotator cuff does not properly perform its functions. As a result, the rotator cuff becomes pinched against the structures along the upper portion of the shoulder or coracoacromial arch. If left untreated, it can lead to chronic wearing, tendonitis and subsequent tearing of the rotator cuff tendons. In more advanced stages of the syndrome, bony spurs begin to form further limiting the size of the subacromial space.
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Impingement Syndrome can be broken down into two basic classifications: primary impingement and secondary impingement.
Only a physician, physical therapist or other health care professional can properly diagnose Impingement Syndrome as it is important to rule out conditions that produce similar symptoms such as cervical spine defects or injuries.
Treatment includes a twofold process of reducing inflammation to increase the subacromial space in conjunction with strengthening the rotator cuff muscles to restore balance and stability. If left untreated and the condition is allowed to progress without intervention, Impingement Syndrome may progress to higher stages potentially causing serious medical issues.
Stage 1: Edema and Inflammation: Early stage impingement is distinguished by pain during and after the attempt to perform certain positions and motions.
Stage 2: Fibrosis and Tendonitis: There is a marked loss of motion commingled with pain, weakness, inflammation and tendon involvement. It is difficult to lift the arm overhead independently. Joint noise, also know as grinding “crepitus,” may be present.
Stage 3: Bony Spurs and Tendon Ruptures: Painful bone spurs may form further reducing the range of motion with tendon ruptures happening in the worst cases. The severity of damage to the region will dictate the magnitude of weakness, degenerative changes, decrease of motion and pain felt by the individual.
As discussed earlier, it is crucial to consult with a health care professional to get the correct diagnosis since the course of treatment is contingent on the underlying condition. In general terms, a conservative treatment plan should be implemented to see if symptoms can be alleviated by less intrusive measures such as physical therapy as opposed to invasive surgery. Each program should be tailored towards a patient’s individual needs as the ability to regain motion and ability differs from case to case. A treatment program may include:
Under a comprehensive physical therapy rehabilitation program, many patients with early stage Impingement syndrome will likely see a decrease in symptoms over a 3-month period. For patients with more advanced cases or if results are not realized after a 3-month period, surgical intervention may be considered.
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Dr. Eric D. Freeman is a top-rated, best-in-class pain management doctor. He is a nationally recognized pain relief specialist and is among the top pain care doctors in New Jersey and the country. He is an award-winning expert and contributor to prominent media outlets.
Dr. Eric D. Freeman has been recognized for his thoughtful, thorough, modern approach to treating chronic pain. He has been named a “top pain management doctor in New Jersey” and one of “America’s Top Physicians” for advanced sports injury treatments.
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