Subacromial Impingement - How It Can Be Managed?

Subacromial impingement is a very common problem relating to the shoulder area, accounting for almost 50% of the shoulder pain complaints. It is a very small space covered by bones on all spaces, and in fact, only when there is inflammation in this area does the space become evident on radiographs. There are various tendons and muscles, which work together to allow for shoulder movement upwards and downwards and front and the back. With repeated movements, these tendons get impinged or pinched and so cause limited motion, pain, swelling, instability, etc.

This injury is very common in people who use the shoulder repeatedly and in similar movements, especially with sportspersons like basketball, swimmers, etc. Non-sportspeople like painters and construction workers can also sustain this injury, given the repetitive motion of the shoulder joint.

What causes subacromial impingement?

1. Irritation and impingement of the shoulder joint due to repeated motion
2. Acute injury or accident involving the shoulder
3. Poor posture where shoulders are constantly in a stooped position
4. Shoulder instability

If a person has subacromial impingement, the symptoms will include:

1. Pain in lifting shoulder to the front and above the head
2. Weakness in the shoulder with gradual loss of function
3. Swelling and stiffness of the shoulder
4. Night pain, especially with rolling the shoulder
5. Limited movement
6. Hemorrhage in advanced cases

As the condition progresses, the symptoms worsen and gradually can lead to calcifications in the tendon space and loss of shoulder strength. The impingement can go through 3 stages, with both age and symptoms increasing with each stage.

Diagnosis: A combination of history, clinical presentation, x-ray, and MRI are used in diagnosis. Specific tests like empty can are also useful in arriving at a diagnosis.

Management: Conservative measures like resting, ice and heat therapy, medications, and exercise are the first line of therapy. When the condition persists even after 3 to 4 months, then surgical intervention is required.

1. Avoid activities which cause repetitive movement of the shoulder.
2. Ice the area for 10 to 15 minutes every 4 to 6 hours through the day to reduce the inflammation.
3. Compression also can be used which will help in pain control.
4. Keep the shoulder elevated like in a sling to help in pain relief.
5. Nonsteroidal anti-inflammatory medications can help control inflammation and pain, improve movement, and reduce swelling or stiffness.
6. Exercise can be included in the daily routine as it improves the shoulder strength and flexibility.
7. Surgery is usually considered the last resort. It is only when all the conservative measures fail, surgery is advised.

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