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 layer of lubricating fluid, called the bursa, which 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 rotator 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
Our team at LALL Orthopedics + will review your medical history including when and under what conditions you experience shoulder pain and other symptoms. They will conduct a thorough physical exam checking for pain and tenderness and will evaluate your shoulder range of motion and perform specific tests to identify damage to the rotator cuff. They will order x-rays to view the bones and identify shoulder arthritis or bone spurs, and an MRI to evaluate the rotator cuff tendons for tears.
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 regenerative medicine such as Stem-Cell or Platelet-Rich Plasma (PRP) injections to reduce inflammation and pain. Nonsurgical treatment aims to improve shoulder pain and function with the hopes of avoiding surgical intervention.
If needed, surgical correction of shoulder impingement includes removal of impinging bone spurs and repair of underlying tissue damage, if any, to the rotator cuff muscles. This procedure is best performed by expert surgeons who utilize minimally-invasive arthroscopic techniques.
Dr. Ajay C. Lall is a former dual sport NCAA collegiate athlete (football and track & field), American board certified, triple fellowship-trained expert orthopedic surgeon who specializes in hip arthroscopy, robotic hip replacement and cutting-edge regenerative medicine such as platelet-rich plasma (PRP) and Stem-Cell therapy. He treats non-athletes and athletes at all levels of play from collegiate to professional to the Olympic level. Dr. Lall is a world-renowned orthopedic surgeon who cares for all patients like family. Contact LALL Orthopedics + to schedule a consultation, receive the correct diagnosis, and undergo state-of-the-art treatment options.
At a Glance
Ajay C. Lall, MD, MS, FAAOS
- Board Certified – Orthopedic Surgery
- Triple Fellowship Trained
- Performs over 750 Surgeries Per Year
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