SHOULDER IMPINGEMENT SYNDROME

The shoulder impingement syndrome (SIS) symptom is pain that occurs when the person lifts his or her arms overhead or reaches backward. The pain can eminate from the shoulder, near the top of the arm, or down the outside of the arm, and it frequently happens at night or when the person lies on the affected shoulder.

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Shoulder Impingement Syndrome

Shoulder Impingement Syndrome, also known as Rotator Cuff Tendinitis or Subacromial Impingement Syndrome, is a common condition that affects the shoulder joint. It is characterized by pain and limited movement in the shoulder joint, particularly when raising the arm.

This condition is usually caused by repetitive overhead movements—for instance, movements performed by athletes, painters, and manual laborers. However, this syndrome can also occur from a traumatic shoulder injury to the shoulder joint or by lifting heavy objects.

Shoulder impingement occurs when the tendons or bursa in the shoulder become pinched or “impinged” by the surrounding bones—most often as they pass through the narrow subacromial space beneath the top of the shoulder blade (the acromion). This is why the condition is sometimes referred to as “swimmer’s shoulder” or “thrower’s shoulder.” For example, repetitive overhead motions, like swimming or throwing a ball, can repeatedly pinch the rotator cuff tendons, causing inflammation and irritation. As these tendons become more inflamed, they may swell, making the impingement worse and leading to greater pain and dysfunction.

Why Is Shoulder Impingement Called “Swimmer’s Shoulder” or “Thrower’s Shoulder”?

You may have heard shoulder impingement syndrome nicknamed “swimmer’s shoulder” or “thrower’s shoulder.” These names come from the repetitive arm motions common in sports such as swimming, baseball, or tennis—activities that involve frequent overhead movement. Each time the arm moves above the head, there’s potential for the rotator cuff tendons to become pinched within the tight space beneath the acromion, a bony part of the shoulder blade.

Repeated motions like those in a freestyle stroke or pitching a baseball can create ongoing friction and pressure on the tendons or bursa in the shoulder. Over time, this leads to irritation, swelling, and persistent pain, classic symptoms of impingement syndrome. That’s why athletes and individuals with hobbies or jobs that demand frequent overhead arm use are often most at risk, giving rise to these familiar nicknames for the condition.

QUESTIONS AND ANSWERS

What causes shoulder impingement in children, and is it common?

Shoulder impingement in children can result from various factors, including overuse of the shoulder joint, repetitive overhead movements (common in certain sports like swimming or baseball), or anatomical factors. It may also be associated with muscle imbalances or poor shoulder mechanics. While it may not be as common in children as in adults, shoulder impingement can occur, especially in those engaged in sports or activities that place repetitive stress on the shoulder.

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Treatment

Treatment for shoulder impingement in children typically involves a combination of rest, physical therapy, and activity modification. The doctor may recommend specific exercises to strengthen the muscles around the shoulder and improve posture. Resting the shoulder and avoiding activities that exacerbate symptoms may be necessary during the initial phase of treatment. Once symptoms improve, gradual return to sports and activities can be considered, with proper attention to preventive measures and modifications to reduce the risk of recurrence.

Is shoulder impingement a long-term concern, and can it lead to permanent damage?Your Title Goes Here

Long Term Concerns

With early intervention and appropriate treatment, many children with shoulder impingement can experience significant improvement in symptoms and function. However, the long-term outlook depends on factors such as the severity of the impingement, adherence to the treatment plan, and any underlying anatomical issues. If left untreated or if the impingement is severe, there is a risk of progressive damage to the rotator cuff tendons, potentially leading to chronic issues.

Regular follow-up with the healthcare provider and compliance with rehabilitation exercises are crucial to monitor progress and prevent long-term complications.
Most children recover well with a combination of rest, anti-inflammatory medications, and rehabilitation exercises focused on strengthening and improving shoulder mechanics. Avoiding activities that strain the shoulder, especially repetitive overhead movements, can speed up healing and reduce discomfort. Before returning to regular activities or sports, it’s important to work closely with your doctor and physical therapist to ensure a safe transition and prevent re-injury.

In rare cases where conservative treatments do not resolve symptoms, surgical intervention may be considered. Outcomes for surgery in pediatric patients are generally positive, with most returning to their previous level of activity. However, high-performing athletes may experience a longer recovery or less predictable results after procedures such as decompression surgery. Ongoing medical guidance and adherence to a personalized rehabilitation plan remain essential for optimal recovery and long-term shoulder health.

Parents should consult with their child’s healthcare provider for personalized advice and guidance regarding shoulder impingement. The doctor will assess the specific circumstances of the child’s condition and provide recommendations tailored to their needs and activities.

The doctors at the Medical City Children’s Orthopedics and Spine Specialists Practice only treat children.

As such, our doctors have become experts with children and adolescents and treat their bodies and shoulder impingement. We urge parents to bring their children to us to ensure proper treatment and healing.

There are Several Types of Shoulder Impingement Syndrome, Including Primary, Secondary, and Internal Impingement.

Primary impingement occurs when there is a structural abnormality in the shoulder joint. For example, a bone spur or a thickened acromion causes the rotator cuff tendons to rub against the bone.
Secondary impingement occurs when there is an underlying condition that causes inflammation in the shoulder joint. For instance, bursitis or tendinitis.
Internal impingement occurs when the rotator cuff tendons become trapped between the humeral head and the glenoid fossa. This will cause pain and a limited range of motion.

Shoulder Impingement Syndrome Symptoms

The most common symptom of Shoulder Impingement Syndrome is pain in the shoulder joint, particularly when raising the arm. The pain is usually felt on the front and side of the shoulder. It also may make a sound, a clicking or popping sensation. Often, this pain develops gradually, starting old but worsening over time, especially with repeated overhead movements. Some individuals also report that the pain is most severe when the arm is held out to the side. If the arm turns outward, the pain can become persistent enough to interfere with daily activities. Simple motions like reaching overhead to put on clothes can trigger discomfort. The pain is frequently more noticeable at night or when lying on the affected shoulder.

Other symptoms include weakness in the shoulder, limited range of motion, and difficulty performing overhead activities.

Shoulder Impingement Syndrome Diagnosis

A diagnosis of Shoulder Impingement Syndrome is typically made through a physical exam and imaging tests. The imaging includes X-rays or MRI scans. During the physical exam, the doctor will assess the range of motion in the shoulder joint. In addition, the doctor will test the strength of the rotator cuff’s muscles and look for signs of inflammation or structural abnormalities. Imaging tests can help confirm the diagnosis and identify any underlying conditions that may contribute to the impingement.

What Causes Shoulder Impingement in Children, and is it Common?

Shoulder impingement in children can result from various factors, including overuse of the shoulder joint, repetitive overhead movements (common in certain sports like swimming or baseball), or anatomical factors. It may also occur with muscle imbalances or poor shoulder mechanics. While shoulder impingement is not as common in children as in adults, it can occur. Especially, in those engaged in sports or activities that place repetitive stress on the shoulder.

Shoulder Impingement Syndrome Treatment

Treatment options for shoulder impingement syndrome depend on the severity and underlying cause of the condition. In general, there are two types of treatment: non-surgical and surgical.

Treatment for shoulder impingement in children typically involves a combination of rest, physical therapy, and activity modification. The doctor may recommend specific exercises to strengthen the muscles around the shoulder and improve posture. Resting the shoulder and avoiding activities that exacerbate symptoms may help during the initial phase of treatment. Once symptoms improve, a gradual return to sports and activities can happen. However, parents must ensure that they pay attention to preventive measures and modifications to reduce the risk of recurrence.

Important Points

With early intervention and appropriate treatment, many children with shoulder impingement can experience significant improvement in symptoms and function. However, the long-term outlook depends on factors such as the severity of the impingement, adherence to the treatment plan. Also, will pay attention to any underlying anatomical issues. If left untreated or if the impingement is severe, there is a risk of progressive damage to the rotator cuff. This can lead to potential chronic issues. Regular follow-up with the doctor and compliance with rehabilitation exercises are crucial to prevent long-term complications.

Non-surgical treatments for shoulder impingement syndrome include:

Rest: Reducing or avoiding activities that aggravate the shoulder can help reduce pain and inflammation.
Ice therapy: Applying ice to the shoulder can help reduce pain and swelling. Patients should apply ice for 15-20 minutes at a time, several times a day.
Physical therapy: Physical therapy can help to improve the range of motion, reduce pain, and strengthen the muscles around the shoulder joint. Exercises may include stretches, range of motion exercises, and strengthening exercises. Your doctor may recommend working with a physical therapist to develop a personalized exercise program. The PA will target the rotator cuff and surrounding muscles.
Anti-inflammatory medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation. Over-the-counter options include ibuprofen and naproxen. In some cases, your physician may prescribe anti-inflammatory medications to ensure the condition is fully addressed.
Corticosteroid injections: Injecting corticosteroids into the shoulder joint can help reduce inflammation and relieve pain. This treatment is typically reserved for cases that do not respond to other treatments. For more severe or persistent symptoms, a cortisone injection may be recommended. Cortisone is a powerful anti-inflammatory medication that is injected directly into the affected area. However, doctors should prescribe its use sparingly, as too many injections can weaken the muscles and tendons.
Activity modification: Avoiding repetitive overhead movements and making adjustments to daily activities can help minimize irritation and promote healing.

Important Points

If these nonsurgical treatments are not effective, doctors may consider surgical options like subacromial decompression, Recovery time for non-surgical treatments can vary depending on the severity of the condition and the individual’s response to treatment. Doctors may recommend physical therapy for several weeks to several months to regain strength and flexibility in the shoulder joint. Recovery time for surgical treatments also varies depending on the type of procedure performed.

Generally, recovery can take several months and may require physical therapy to regain strength and flexibility in the shoulder joint. It is important to follow the surgeon’s post-operative instructions and attend all recommended follow-up appointments to ensure proper healing and recovery.

Surgical treatments for shoulder impingement syndrome include:

Subacromial decompression: This is the most common surgical procedure for shoulder impingement syndrome. It involves removing any bone spurs or thickened tissue that may cause impingement. The goal of the procedure is to create more space in the shoulder joint and reduce pressure on the rotator cuff tendons.
Rotator cuff repair: If the rotator cuff tendons are torn, they may need surgery to repair and reattach them to the bone.
Biceps tenodesis: This procedure involves reattaching the biceps tendon to the bone in a different location to reduce pressure on the rotator cuff tendons.

What is acromioplasty, and how does it help with shoulder impingement?

Acromioplasty is a surgical procedure commonly used to address shoulder impingement syndrome. In this procedure, the surgeon carefully removes a small portion of the acromion—the bony prominence on the top of the shoulder blade. By doing so, it creates more space for the rotator cuff tendons and the bursa, relieving the pressure and reducing the risk of further irritation or injury to these tissues.

This added space helps decrease pain and restore smoother movement in the shoulder joint. Acromioplasty is often chosen when non-surgical treatments have not provided enough relief, especially if bone spurs or thickened tissue are contributing to the impingement. The main goal is to prevent long-term damage and help the patient return to normal activities with improved comfort and function.

Shoulder Impingement Syndrome Recovery and Outlook

Recovery time for non-surgical treatments can vary depending on the severity of the condition and the individual’s response to treatment. Doctors may recommend physical therapy for several weeks to several months to regain strength and flexibility in the shoulder joint. Most patients recover well with rest, anti-inflammatory medications, rehabilitation, and by avoiding aggravating movements.

If surgery is required, recovery time will also depend on the specific procedure performed. Generally, recovery can take several months and may require extensive physical therapy to restore full function and strength to the shoulder. Results from surgical intervention are generally positive, with the majority of patients—about 85%—returning to their previous level of shoulder function. However, high-performing athletes may experience more variable outcomes after decompression surgery.

It is important to follow the surgeon’s post-operative instructions and attend all recommended follow-up appointments to ensure proper healing and recovery. Working closely with your healthcare provider and physical therapist is essential for achieving the best possible outcome and safely returning to everyday activities and sports.

Outcomes of Surgery in High-Performing Athletes

While surgical intervention for shoulder impingement syndrome is generally successful, with most patients (about 85%) achieving a return to their prior level of shoulder function, it’s important to recognize that high-performing athletes may encounter different results. Although everyday activities and even recreational sports are typically resumed with good outcomes, athletes who place exceptional demands on their shoulders, such as baseball pitchers or competitive swimmers, may not always regain their full pre-injury performance.

These individuals often face a longer and more challenging recovery and may find it difficult to return to the same level of competition. The unique stresses placed on an athlete’s shoulder can lead to a slower or less complete return compared to non-athletes or those at lower levels of competition. This underscores the importance of personalized rehabilitation plans and open communication with your orthopedic specialist during recovery.

Shoulder Impingement Syndrome Prevention Measures

Prevention measures for Shoulder Impingement Syndrome include avoiding repetitive overhead activities and maintaining good posture while sitting and standing. Also, it is important to warm up properly before engaging in physical activity. Using the proper technique when lifting or carrying heavy objects is very important. Strengthening the rotator cuff muscles through exercise can also help prevent impingement.

Shoulder Impingement Syndrome Recovery

Recovery time for Shoulder Impingement Syndrome varies depending on the severity of the condition and the type of treatment used. Non-surgical treatments may take several weeks to several months to fully alleviate symptoms and improve the range of motion. Surgical recovery may take several months and may require physical therapy to regain strength and flexibility in the shoulder joint.

Conclusion

In conclusion, shoulder Impingement Syndrome is a common condition that can cause pain and a limited range of motion in the shoulder joint. It can be caused by repetitive overhead activities, traumatic injury, or underlying conditions such as bursitis or tendinitis. Finally, diagnosis is typically made through a physical exam and imaging tests, and treatment may involve non-surgical approaches such as rest, ice, physical therapy, and anti-inflammatory medications, or surgical approaches.

Selecting a pediatric orthopedic doctor for your child is a crucial decision that requires careful consideration. By seeking recommendations, researching credentials, assessing hospital affiliations, reviewing patient testimonials, evaluating communication and bedside manner, considering the supportive team, discussing treatment options, seeking second opinions, prioritizing accessibility, and trusting your instincts, you can make an informed choice. Remember, finding the right orthopedic doctor will ensure that your child receives the best possible care. Our doctors ensure the best possible outcomes and a healthier, happier future. The Medical City Children’s Orthopedics and Spine Specialists doctors only treat children. With offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, Texas, Doctors Shyam Kishan, Richard Hostin, and Kathryn Wiesman have spent years studying children’s health and have devoted their lives to treating them.

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Footnote:

American Academy of Orthopaedic Surgeons: Shoulder Impingement

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