When your shoulder hurts and movement is difficult, and you feel it crack and pop and everything feels like it’s rubbing together, it may be shoulder impingement syndrome.
Shoulder impingement syndrome is a painful condition in which more than one aggravation is occurring at the same time within the shoulder. The term syndrome refers to a collection of symptoms or signs that collectively contribute to a condition or complex.
Shoulder impingement syndrome typically manifests itself with somewhat of a slow onset and progression of symptoms beginning with mild aching in the shoulder. A specific causative incident may not be evident. An impingement syndrome can often be the result of long-term overuse or repetitive use activities.
Impingement can consist of several factors; (1) rotator cuff tendinitis, (2) sub-acromial bursitis (the bursa sac located above the rotator cuff, but underneath the acromion, or bony roof of the shoulder girdle), (3) bone spur formation on the underside of the acromion. Additional problems can include biceps tendinitis and arthritis of the acromion-clavicle joint.
The bony roof of the shoulder, the acromion, is made up of the front portion of the shoulder blade and is shaped in a manner that offers protection to the inner moveable structures such as the joint itself, rotator cuff and bursa sac.
The natural shape of the acromion has varying degrees of down-sloping. Any excess sloping sets the table for friction to be exerted against the underlying bursa sac and rotator cuff located beneath that.
When bone spurs and down-sloping acromial bone edges begin to rub over the bursa sac and cuff, inflammation begins to brew. The vicious cycle now begins–inflammation increases, which leads to increased pain and tissue swelling, which creates an even tighter space for all components to move within. The bursa sac becomes thickened and enlarged. The tendons making up the rotator cuff also become inflamed, swollen and painful. Overall, shoulder motion decreases and the risk of frozen shoulder increases.
Common complaints include decreased mobility of the shoulder, together with pain that can be felt during specific ranges of motion.
Diagnosis of impingement syndrome is typically through clinical/physical examination, x-rays and perhaps even an MRI study. Another diagnostically important technique is the cortisone injection. Steroid mixed with a local anesthetic is injected into the shoulder joint and sub-acromial space and allowed to sit for a few minutes. After adequate onset of the medication, the shoulder is re-examined. If pain has been noticeably reduced or eliminated with the same movements that elicited pain just minutes earlier, the test is said to be positive for impingement syndrome.
Conservative treatment of impingement syndrome typically includes physical therapy for motion and pain control together with oral medication for pain and inflammation. Cortisone injections are commonly used as well.
In more severe cases, and for those who developed frozen shoulder from limited mobility, manipulation of the shoulder under a general anesthesia is very helpful in breaking up adhesions and thickened joint capsular tissue within the shoulder caused from inflammation.
Occasionally, shoulder manipulation under anesthesia is accompanied by performing a shoulder arthroscopic procedure. This can be very beneficial in that other problem areas can be addressed and treated arthroscopically, such as removing the inflamed bursa sac as well as grinding down the offending bone spurs that rub against the bursa and rotator cuff. In these cases, aggressive physical therapy is often begun very early in the recovery phase to maintain the amount of mobility recovered in surgery.
So if your shoulder is aching and you don’t remember doing anything to it, and it’s getting worse, it may well be impingement syndrome. Get it checked out by your family physician or orthopedic surgeon sooner rather than later.
Chisholm’s expertise in nursing, orthopedics and surgery spans more than 30 years. He holds multiple national certifications in these specialties. Submit questions or comments to Ken at