Shoulder pain – is it impingement syndrome or a rotator cuff tear?

Have you or a loved one been diagnosed with shoulder impingement or a rotator cuff tear? Are you unsure of what they are or how they’re treated? Look, no further, we have you covered.

“Shoulder pain is the third most common musculoskeletal complaint in orthopedic practice. It is usually due to a defect of the rotator cuff and/or an impingement syndrome.¹” Shoulder Impingement is an inflammatory condition. It occurs when the space in the shoulder (glenohumeral joint) is decreased.

Typically this occurs when the space between the top of the shoulder, (the acromion), and the humerus is decreased. As the space decreases, the bones rub and compress the tendons of either the biceps tendon or the rotator cuff between these two bones. Although the primary cause of decreased space in the shoulder is due to age, and age related degeneration, there are other causes.^1,2 With primary impingement, the onset is usually gradual or insidious. It typically develops over weeks to months, and individuals are unable to describe a trauma or event that caused the pain.² Other, secondary, causes of impingement include injury to the biceps or rotator cuff that causes inflammation. These injuries can lead to changes in a person’s body mechanics that increases impingement on the injured tendons, causing further inflammation. Other cases include trauma due to a fall, poor mechanics with lifting, and overuse (typically seen in manual jobs with overhead activities, and sports). Common symptoms include: pain with movement, pain when lying on the affected shoulder, pain with overhead activities, pain and tenderness in the front of the shoulder, pain when reaching behind the back, shoulder weakness, and trouble sleeping. Impingement can be diagnosed by a medical professional such as a physical therapist (PT). The PT will review your history, assess your range of motion, and perform some tests to confirm the diagnosis.^1,2

How is impingement treated? Oftentimes, your doctor will prescribe anti-inflammatory medication and may even prescribe an injection to decrease inflammation in the early phases of treatment. Many people often benefit from conservative treatment with PT. A PT will teach you important stretches and proper body mechanics to increase the space in your shoulder, and decrease the compression of the tendons in the shoulder. You will also learn activity modification in the early stages, and how to return to normal activities safely. In the later stages, the PT will help you increase and regain your strength and ability to perform overhead activities.^1,2

What does the research say?

1. “Conservative treatment yields satisfactory results within 2 years in 60% of cases. If symptoms persist, decompressive surgery is performed as long as the continuity of the rotator cuff is preserved and there is a pathological abnormality of the bursa. The decision to treat conservatively or surgically is generally made on the basis of the duration and severity of pain, the degree of functional disturbance, and the extent of structural damage. The goal of treatment is to restore pain-free and powerful movement of the shoulder joint.¹”
2.  “A 2018 systematic review found there was no additional benefit in pain reduction when comparing the results of arthroscopic subacromial decompression surgery to placebo surgery at 12 months. When comparing surgical intervention with physiotherapy to that of surgery alone, no statistically significant or clinically significant difference between the two arms was observed with respect to pain at 3 months, 6 months, 5 years, and 10 years.²”

References:

1. Garving C, Jakob S, Bauer I, Nadjar R, Brunner UH. Impingement Syndrome of the Shoulder. Dtsch Arztebl Int. 2017;114(45):765-776. doi:10.3238/arztebl.2017.0765
2. Creech JA, Silver S. Shoulder Impingement Syndrome. [Updated 2020 May 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554518/