By Consultant Orthopaedic Surgeon Hagen Jahnich
Shoulder pain is a very common problem and can hit any age group. However “impingement” is most common, but not exclusive, in the age group of 40 to 60.
But what is impingement?
Impingement means that during use of the shoulder something catches and leads to referred pain (pain felt in another part of the body other than its source), typically into the side of the shoulder. But pain can also refer down the arm and up the neck. Impingement is a symptom, not a diagnosis!
Causes and treatment of shoulder impingement
There can be many causes for impingement; this article will highlight many of those.
The impingement pain may not originate in the shoulder at all. It can be referred from the neck, even the gall bladder or the heart and for instance, may be a sign of a slipped disc in the neck.
There may be no structural reason for such symptoms and simple muscle imbalance or poor posture are common causes. This is corrected by good physiotherapy and self help, like participating in Pilates.
If treatment after two months does not show any improvement then a formal assessment is required. Local and national guidelines suggest your GP should organise an X-ray of your shoulder. As long as the X-ray is normal, the trained therapist, the GP or the shoulder specialist may try a single injection with steroids.
An X-ray may identify calcium around the shoulder or bony spurs pressing onto the tendons of the shoulder. One could see early arthritis and many other problems. Calcium in the tendon can burst and irritate the shoulder. This leads to severe pain. A steroid injection, with or without image guidance, may settle things down again. But larger amounts of calcium may require to be removed by keyhole surgery (arthroscopy).
Bony spurs tend to form at the under surface of the tip of the shoulder (the acromion). Physiotherapy and injections are again the start of the management but when symptoms persist or if there is concern for the rotator cuff tendon, then keyhole surgery could be the answer. Furthermore, there may be arthritis in the ACJ (acromio-clavicular Joint, the joint between collar bone and shoulder blade). It may lead to localised pain but also to impingement. Often though, it is an incidental finding. Most X-rays will show some arthritis in the ACJ. However, if it is not the cause for symptoms then it should not be treated.