The shoulder is a shallow joint with a large number of movements. A number of conditions cause shoulder pain, including subacromial impingement syndrome. This condition causes compression of a tendon or bursa, which occurs just below the acromion. The acromion is the part of the shoulder joint that protects the socket and socket of the shoulder joint and looks like a roof of bone. Due to this syndrome, the patient not only experiences shoulder pain but also a limited range of motion of the shoulder. Both conservative and surgical treatment options are available to relieve pain and improve shoulder function.

• Synonyms
• Epidemiology of shoulder disorder
• Causes of subacromial impingement syndrome
• Symptoms: Shoulder pain and limited range of motion
• Diagnosis and examinations
• Treatment of shoulder pain
• Prognosis of impingement of tendon or bursa just below acromion

Synonyms

Other names for subacromial impingement syndrome are:

• tendonitis (tendonitis) and bursitis (inflammation of the mucous membranes) in the shoulder
• subacromial pain syndrome

Epidemiology of shoulder disorder

Shoulder pain is the third most common musculoskeletal pain condition in orthopedic practice. Shoulder pain is usually due to a rotator cuff defect and/or impingement syndrome. Subacromial impingement syndrome is a fairly common cause of shoulder complaints. In the Netherlands, approximately 2 in 100 people are affected by shoulder disease every year. This painful shoulder condition occurs in patients of all ages, but people between the ages of forty and sixty are particularly affected. Finally, men are more often affected by shoulder pain than women.

Causes of subacromial impingement syndrome

A bursa ensures that there is less friction between bones and muscles. The tendon connects a muscle and bone. In subacromial impingement syndrome, a tendon or bursa is pinched just below the acromion. Subacromial impingement syndrome is caused, for example, by a fall, tendon calcification or overuse of the shoulder. This causes irritation or inflammation of the bursa and/or tendons in the space between the shoulder roof and the shoulder head. Inflammation causes swelling of the bursa and/or tendon, causing the shoulder tip to have insufficient space to move under the roof of the shoulder, resulting in pain. Shoulder instability is another cause of the complaints.

Symptoms: Shoulder pain and limited range of motion

In 95% of patients, the symptoms occur in one shoulder. Subacromial impingement syndrome causes pain due to inflammation of the mucous membrane (bursitis) and tendonitis (tendonitis) of the shoulder. It is very painful for the patient to move the arm to the side (away from the body). This severe dull to flaming pain, which even keeps the patient awake at night, radiates (radiating pain) to the upper arm, the neck (neck pain), the elbow (elbow pain) and the hand (hand pain). Raising the arm sideways worsens the complaints. This makes some daily activities more difficult, such as putting on or taking off a coat or other clothing, brushing the teeth, brushing the hair, etc.

Diagnosis and examinations

When the doctor examines the back of the shoulder, the shoulder blade rotates earlier than usual during shoulder raises. A passive elevation reduces impingement and is less painful. Severe pain renders the joint virtually immobile (immobile), although some rotational movements remain possible. Furthermore, the patient also has a painful cramp of the trapezius muscle. Sometimes subacromial bursitis (bursitis below the shoulder tip) appears. An X-ray, ultrasound and/or MRI scan are necessary to confirm the condition and rule out other shoulder problems, such as tendon calcification and osteoarthritis (rheumatic disease of articular cartilage) in the shoulder.

Treatment of shoulder pain

Painkillers or NSAIDs (non-steroidal anti-inflammatory drugs) are often sufficient, but severe pain requires an injection of corticosteroids (powerful anti-inflammatory drugs) into the subacromial bursa. This injection does worsen the pain by up to 10% during the first 24-48 hours after the injection. In seventy percent of patients, the symptoms improve within 5-20 days after the injection has been given. Further injections are sometimes necessary. It is also possible to puncture and aspirate tendon calcifications using local anesthesia using ultrasound. Occasionally, surgery is required where the surgeon provides more space for the tendon. In this way he removes a piece of bone from the shoulder roof. Physiotherapy and/or manual therapy helps with persistent joint stiffness and may speed up recovery. Some patients benefit from acupuncture. Finally, the application of heat and/or electricity is helpful for some patients.

Prognosis of impingement of tendon or bursa just below acromion

Most patients notice an improvement in their symptoms within a few weeks to months.

read more

• Shoulder pain: Causes of shoulder joint pain
• Pain radiating to shoulder: Shoulder pain due to condition