Impingement SyndromeDr. Howard Liss treats disorders that cause pain and disability by providing consultative services and soft tissue and joint injections when needed. When medically appropriate, he makes specific referrals for diagnostic testing (lab work, imaging, electrodiagnosis), physical and occupational therapy, interventional procedures (epidurals and facet joint injections), and surgery.
Impingement syndrome is recognized by multiple names such as subacromial impingement, painful arc syndrome, supraspinatus syndrome, swimmer’s shoulder and thrower’s shoulder. It is marked by irritation and inflammation of the tendons of the rotator cuff as they pass through a narrow channel called the subacromial space. This space is located beneath the acromion, which is a bony structure that arches over the shoulder joint. Essentially, tendons of the rotator cuff become trapped and compressed intermittently during shoulder movements, causing pain and swelling. Though impingement syndrome can be a result of overuse, such as repeated overhead movements (throwing, racket sports and swimming), it may also follow a partial tear to the rotator cuff tendon.
To better classify impingement syndrome, it’s important to understand that is it not a diagnosis, but a clinical symptom caused by a variety of other orthopedic conditions or sports injuries. Some include rotator cuff injuries, labral injuries, shoulder instability, biceps tendinopathy, scapula dysfunction and bone spurs. Most cases of impingement syndrome involve the supraspinatus muscle, which is a small muscle of the rotator cuff that aids in the abduction (raising) of the arm and provides support for the humerus bone running from the shoulder to the elbow. With primary and secondary causes, shoulder impingement may be a result of a structural condition (shoulder instability) or it may be related to posture, positioning or poor technique.
As repeated use of the supraspinatus muscle causes pain and discomfort, particularly in the rotator cuff, it is believed that the humerus bone shifts slightly in response to pain and dysfunction of the rotator cuff tendons. In effect, inflammation may occur in a small fluid-filled sac (bursa). As pain increases, impairment increases, leading to an increased risk of developing bone spurs and serious injury to the rotator cuff.
Shoulder Impingement Symptoms
Shoulder impingement is often associated with athletes and trainers that engage in physical activities involving repetitive overhead movements. As with tennis, golf, baseball, swimming or lifting, some occupations require overhead lifting, pulling or concentrated work above shoulder level that may contribute to rotator cuff impingement. Individuals commonly note the following symptoms:
- Increased shoulder pain when the arm is at shoulder height or above (this is the shoulder impingement zone)
- Shoulder pain from the top of the shoulder to the elbow
- Shoulder pain at rest (as condition worsens)
- Muscle weakness or pain when attempting to lift the arm
- Pain that increases when the hand is placed behind the back or head
- Pain during reaching or lifting, including reaching for a seat belt
Treatment and Rehabilitation for Impingement Syndrome
Without question, early attention and treatment of impingement syndrome is the best way to avoid deterioration or a serious, long-term injury. In turn, because rotator cuff impingement can set in motion a series of problems and injuries in surrounding structures, it is critical to take notice of symptoms early and seek expertise for a proper diagnosis.
In terms of control, stability and injury prevention, the rotator cuff serves an important role, maintaining the position of the ball and socket joint. In addition, the rotator cuff allows for smooth shoulder movements, while the shoulder blade (scapula) acts as a stable foundation that connects the arm to the chest wall.
Initial treatment of impingement syndrome will focus on reducing pain and inflammation conservatively with tried and true methods such as rest, ice therapy, bracing or steroid injections. When pain and swelling are at bay, physiatrists can better assess and determine appropriate and specific rehabilitation techniques. These techniques help patients regain full shoulder range of motion, restore scapular control and rhythm, restore the function of the neck in relation to the scapula, shoulder and thoracic region, restore rotator cuff strength and improve power, agility and overall function.
A series of exercise therapies, including stretching and flexibility training will be administered, as well as injury-specific training, ultrasound, electrotherapy, TENS unit, joint mobilization and neurodynamics. Also part of rehabilitation, patients are educated on body mechanics, including behavior and activity modification that will promote healing and prevent future injury.
While treatment and rehabilitation provide relief and support to patients, important diagnostic information is related to the physiatrist, optimizing patient care.
At the Howard Liss, M.D. Rehabilitation Institute in Tenafly, patients can rely on Dr. Liss to put together the right treatment, therapy and rehabilitation plan to ensure the most optimal outcome. Dr. Liss works closely with other specialists required to rehabilitate patients suffering from chronic pain or serious injuries, and Dr. Liss will refer patients as needed to ensure appropriate treatment. With extensive education and exposure to a variety of conditions that affect the cervical and lumbar spine, bones, nerves, joints, ligaments, tendons, muscles, brain, and spinal cord, Dr. Liss is uniquely positioned to help patients manage their pain and maximize their functioning.
To schedule your appointment, contact the Howard Liss, M.D. Rehabilitation Institute today.