What is impingement syndrome?

Shoulder impingement syndrome occurs when the tendons of the rotator cuff and the subacromial bursa are pinched in the narrow space beneath the acromion (undersurface of the shoulder blade). This causes the tendons and bursa to become inflamed and swollen. This pinching is worse when the arm is raised away from the side of the body. Impingement may develop over time as a result of a minor injury, or as a result of repetitive motions that lead to inflammation in the bursa.

Particular shapes of the acromion may make certain individuals more susceptible to impingement problems between the acromion and the bursa. With age and the onset of arthritis, the acromion may develop bone spurs that further narrow this space. Impingement caused by bone spurs on the acromion is common in older patients who participate in sports or work activities that require overhead positions. Spurs may also result if one of the ligaments in the coracoacromial arch becomes calcified.

Impingement is classified in three grades:
· Grade I is marked by inflammation of the bursa and tendons.
· Grade II has progressive thickening and scarring of the bursa.
· Grade III occurs when rotator cuff degeneration and tears are evident.
What are the signs and symptoms of impingement syndrome?

Most often the onset of symptoms is related to an episode of overuse. In many patients, the episode occurred some time in the past and the shoulder has failed to return to normal.

Impingement symptoms are marked by pain:
· The pain is sharp and intermittent in its early stages. As impingement progresses, the pain becomes more of a constant ache.
· Although pain is usually present after impingement sets in, the original event that led to the problem is often relatively minor and not remembered as painful.
· Once inflammation starts, simple movements may become painful. Overhead motions tend to increase the pain. There is less space for the bursa when the arm in this position, causing more compression on the bursa.
· Arm movements at waist level are not painful. In this position, there is more space for the bursa, and therefore it is less compressed.
· Pain usually increases at night for two reasons. First, inflammation and swelling tend to get worse as the shoulder is used during the day, and this can lead to more pain in the evening. Second, the mind is usually less occupied in the evening, allowing pain to become a major focus of attention.

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