IMPINGEMENT SYNDROME

Impingement syndrome is a condition that affects the rotator cuff, which is a group of muscles and tendons that secures the arm to the shoulder joint and allows the arm to rotate. When muscle pressure increases it causes loss of blood flow in the small blood vessels. The compression and decreased blood flow results in muscle tissue that begins to fray like a rope. If these muscles are injured for a long period of time, they can tear in two, resulting in a rotator cuff tear. This condition is very painful and often seen in aging adults. It is also closely related to shoulder bursitis and rotator cuff tendonitis. These conditions may occur alone or in combination.

People who engage in physical activities that require repeated overhead arm movements can cause the rotator cuff to become inflamed and swollen. The swollen rotator cuff can get trapped and pinched under the acromion. Some people even rupture their bicep muscles as part of this continuing impingement process. This impingement syndrome results in shoulder pain that can extend from the top pf the shoulder to the elbow. Some of the typical symptoms are:
o Difficulty to elevate the arm
o Significant weakness of shoulder muscles
o Painful when reaching up overhead and behind the back
o Little range of motion
o Flare up during sleep due to pressure on the shoulder area

Diagnosis begins with a medical history that concerns your physical activities and a physical examination of both shoulders by your doctor. Diagnostic test may include:
o X-rays ---------- to check the condition of the bones in the shoulder area
o MRI ----------- to look for tears in the rotator cuff and show any changes in bone
o Ultrasound ----- to indicate muscle and tissue injury
Shoulder pain can sometimes be caused by a problem in the neck area. If impingement syndrome is suspected, the doctor may inject a small amount of pain relieving medication, such as lidocaine hydrochloride, into the space under the acromion. Pain relief from this injection usually indicates impingement syndrome.

The most common treatment for this condition remains to be oral anti-inflammatory medication. Nevertheless, it will not treat the underlying problem and the painful symptoms will come back. The response to any given anti-inflammatory medication differs from person to person. Therefore, if one medication doesn’t work in a couple of weeks, then another one will be given until one that provides relief is found. In addition to taking medications, RICE therapy may be required which consists of:
o Rest or reduced activity
o Ice or cold packs applied to the shoulder
o Compression of the shoulder, such as with ace bandages
o Elevation
Ultrasound therapy may also be recommended to warm the muscles, stimulate the tissues and improve blood flow. In some cases, patients benefit from a limited number of corticosteroid injections into the space under the acromion to reduce inflammation and pain. After the pain is gone, Physical therapy (recommended by your doctor) will help increase the strength of the tendons and muscle If this treatment is not successful within 6 to 12 months, Surgery maybe needed to release the ligament, followed by physical therapy to gradually increase your range of motion. Your physical activities will also need to be modified to reduce the possibility of a relapse.

http://www.hmc.psu.edu/healthinfo/i/impingementsyndrome.htm
http://www.healthopedia.com/rotator-cuff-tendinitis/treatment.html
http://www.webmd.com/osteoarthritis/guide/impingement-syndrome