A condition that commonly affects the shoulder‘s tendonstendonsFibrous bands, one at each end of a muscle, that connect the muscle to bones., impingementimpingementA condition where malpositioned bones restrict movement. If these bones squeeze tendons or other soft tissues,... syndromesyndromeThe aggregate of signs and symptoms associated with any morbid process, and constitution together the picture ... may occur separately or in combination with tendinitis (tendonitistendonitisInflammation of a tendon.) and bursitis.

how do tendons work?

Tendons are fibrous cords that connect muscles to bones. As a muscle contracts, it pulls on the attached tendon and causes the boneboneThe hard tissue that provides structural support to the body. It is primarily composed of hydroxyapatite cryst... to move. The tendon is located between the humerushumerusThe bone of the arm, articulating with the scapula above and the radius and ulna below. (upper arm) bone and the accordion. A layer of tissuetissueA collection of similar cells and the intercellular substances surrounding them. sacs called bursae serves as a cushion between the tendon and the accordion.

Since both the tendon and bursae are so close to one another, it may be difficult to determine which one is the source of the painpainAn unpleasant sensation associated with actual or potential tissue damage, and mediated by specific nerve fibe.... Most often, both are involved.

One of the most common causes of pain in the shoulders of adults, impingement syndrome can lead to further shoulder problems. Here‘s what happens:

• The rotator cuffrotator cuffThe rotator cuff is made up of four muscles and their tendons. These combine to form a "cuff" over the head of... and busae become inflamed and thickened
• They can be compressed under the acromion (front edge of shoulder blade). This pinching of the rotator cuff is called "impingement"—giving the condition its name
• Sometimes a bone spur projection can cause the impingement problem

potential dislocation and rotator cuff problems

Impingement syndrome can become a chronic inflammatory condition that may lead to a weakening of the rotator cuff tendons. This may eventually result in a torn rotator cuff. Shoulder impingement syndrome also is closely related to shoulder instability, such as dislocation.

how is impingement syndrome diagnosed and treated?

The physician will do a thorough physical examination of the shoulder and may ask the patient to go through certain movements, such as raising the arm above the shoulder. The physician also may order x-rays to look at the front edge of the shoulder blade to check for calcium deposits—a condition called "calcific tendinitis." An MRIMRIShort for magnetic resonance imaging. This is a special radiologic test that allows for excellent imaging of t... may be useful to show fluid or inflammationinflammationA local response to injury due to a physical reaction (such as abrasion), or to chemical or biological agents,... in the bursa or rotator cuff.

Initial treatment for an impinged shoulder usually includes rest, ice, and anti-inflammatory medications. The physician also may recommend a corticosteroid injection.

If pain continues and the symptoms don't improve, the doctor may suggest surgerysurgeryThe branch of medicine concerned with the treatment of disease, injury, and deformity by operation or manipula.... The surgery is designed to remove any bone spursspursA sharp, bony outgrowth located at the end of a bone. that are "impinging" the rotator cuff. Inflamed bursae may also be removed.

If the patient and surgeon decide on surgery, the surgeon can advise the patient if the surgery can be done arthroscopically. This form of minimally invasive surgeryminimally invasive surgerySurgery requiring small incision(s), usually performed with endoscopic visualization. allows the orthopaedic surgeon to see inside the shoulder and to carry out procedures through tiny incisions in the shoulder. Recovery time generally is faster.

what can patients with impingement syndrome expect long term?

Shoulder impingement may require more aggressive treatment if conservative management doesn't improve symptoms after several months of treatment. An orthopaedic specialist can advise if surgery is necessary.