Shoulder impingement refers to the pinching of soft tissue structures between the shoulder during movement. Pressure along some structures with shoulder movement is common, however chronic irritation will lead to swelling of poor biomechanics and lead to pain. The bursitis in the shoulder refers to a pathologic inflammation of the sub-acromial bursa which has been inflamed due to an injury or due to chronic compression. A chronic shoulder impingement may lead to bursitis which is an extremely painful pathology. Pain will be present with movements as well as lying on the side. If a shoulder impingement has only affected the tendons, painful positions while playing tennis or in daily life will be present.
Examination will reveal pain and may have difficulty elevating the arm due to pain. There may be any underlying shoulder weakness due to irritation of the tendons. Functional daily tasks may become difficult because of the inability to use the shoulder as previously. Specific assessment manoeuvres will help guide the clinical towards its diagnosis, however specific radiology with ultrasound may be used further investigate and exclude other tissue damage. Contributing factors to a shoulder impingement are the spine and shoulder blade mobility as well as muscle balance. Poor mechanics in the latter may lead to impingement.
The management of the shoulder impingement is commonly conservative with great outcomes. This is achieved with ice, anti-inflammatory medication, and activity modification, followed by correction of structural abnormalities and strength imbalances. However, in cases of severe bursitis a corticosteroid injection may be used directly into the bursa. This has great outcomes and will be used in a shoulder that has failed conservative management.
Surgical management may be used to create more space between the impingement sites. Rehabilitation following surgery includes ice and mobility exercises, followed by strengthening and return to sport training.