Shoulder Impingement Specialist

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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

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What is Shoulder Impingement

Shoulder impingement is a condition that occurs when the tendons of the rotator cuff muscles become compressed or ‘impinged’ during shoulder movements. This compression usually happens between the bones of the shoulder – the head of the upper arm bone (humerus) and a part of the shoulder blade (acromion).

Causes of Shoulder Impingement

The development of shoulder impingement is linked to a combination of factors rather than a single cause.

  • Anatomical Variations
    Some individuals have a variation in their shoulder anatomy, such as a curved or hooked acromion, which narrows the space for the rotator cuff tendons. This makes them prone to impingement.
  • Muscle Weakness
    Weakness in the rotator cuff muscles or the muscles around the shoulder blade can lead to instability in the shoulder joint. This can cause impingement as the humerus moves closer to the acromion.
  • Overuse and Repetitive Activities
    Engaging in activities that require repetitive overhead motion can lead to inflammation and swelling of the tendons, resulting in impingement.
  • Age-Related Changes
    As people age, the risk of shoulder impingement increases due to the wear and tear of the tendons and a decrease in the natural lubrication within the shoulder joint.
  • Trauma or Injury
    A sudden injury or trauma to the shoulder can initiate a cycle of inflammation and impingement.
  • Poor Posture
    Prolonged poor posture, especially with forward-rounded shoulders, can alter the mechanics of the shoulder joint and lead to impingement.

Symptoms and Signs

Recognising the symptoms of shoulder impingement allows for early diagnosis and treatment.


  • Pain: Individuals often experience sharp pain in the front of the shoulder, which can radiate down the arm. The pain is usually more pronounced during activities that involve lifting the arm overhead.
  • Weakness: There may be a noticeable weakness in the shoulder, especially when performing overhead activities or lifting objects.
  • Limited Range of Motion: As the condition progresses, there might be a reduced range of motion in the shoulder, making it difficult to reach overhead or behind the back.
  • Pain During Rest: In some cases, individuals may experience pain even while resting, particularly at night or when lying on the affected shoulder.
  • Swelling and Tenderness: The affected area of the shoulder may exhibit swelling and tenderness to the touch.
  • Crepitus: A grinding or popping sensation may be felt in the shoulder during movement.

Diagnosis

  • The diagnosis of shoulder impingement involves a clinical examination, where the doctor assesses symptoms and medical history, and conducts physical tests to evaluate pain and range of motion.
  • Imaging techniques such as X-rays, MRI, and ultrasound are used to visualize structural changes and inflammation. Impingement tests may also be performed to pinpoint the affected area.

Non-Surgical Treatment Options

Non-surgical treatments aim to reduce pain, decrease inflammation, and improve shoulder function.

Physical Therapy

A tailored physical therapy program that focuses on exercises strengthening the rotator cuff muscles can improve flexibility and enhance the stability of the shoulder joint.

Rest and Activity Modification

Avoid activities that exacerbate the symptoms. Modifying certain tasks can also help reduce stress on the shoulder.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Medications such as ibuprofen or naproxen can help in reducing pain and inflammation.

Corticosteroid Injections

These are injected into the subacromial space. They can provide pain relief and reduce inflammation, though the number of injections is usually limited due to potential side effects.

Application of Heat and Cold

Alternating between heat and cold packs can help in managing pain and swelling.

Assistive Devices

For some patients, using slings or other assistive devices temporarily can provide relief during the healing process.

Surgical Treatment Options

Surgical intervention may be considered in cases where non-surgical treatments have not provided sufficient relief, or when there is damage to the rotator cuff tendons or bursa.

Subacromial Decompression

This is the most common surgery for shoulder impingement. It involves removing a part of the acromion and any inflamed bursa to create more space for the rotator cuff tendons, relieving the impingement.

Rotator Cuff Repair

If there is a tear in the rotator cuff tendons, surgery may be required to repair it. This procedure can be done arthroscopically or through an open surgery, depending on the extent of the tear.

Bursa Removal

Sometimes, it may be necessary to surgically remove the inflamed bursa to reduce pain and improve shoulder function.

Arthroscopy

This minimally invasive surgery uses small incisions and a camera (arthroscope) to diagnose and treat issues within the joint.

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Prevention Strategies

Preventing shoulder impingement involves measures to reduce the risk of developing the condition or preventing its recurrence.

  • Proper Technique in Sports and Activities - Ensuring correct form and technique in sports, especially those involving repetitive overhead motions, can help reduce stress on the shoulder.
  • Strengthening and Conditioning - Regular exercises to strengthen the muscles around the shoulder and improve flexibility can provide better stability and reduce the risk of impingement.
  • Ergonomic Adjustments - Making ergonomic adjustments at work or during daily activities, such as maintaining good posture and avoiding prolonged overhead activities, can help prevent shoulder strain.
  • Regular Breaks and Stretching - Taking breaks during activities that involve repetitive arm movements and practising stretching exercises can minimize the risk of tendon inflammation.
  • Weight Management - Maintaining a healthy weight reduces the overall stress on joints and muscles, including the shoulders.
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Dr Poh Seng Yew

MBBS

MRCSEd

MMED (Ortho)

FRCSEd

With over 18 years of experience, Dr Poh Seng Yew is an orthopaedic surgeon specialising in hip, knee, shoulder and elbow surgery, sports medicine, and trauma surgery.

  • Bachelor of Medicine, Bachelor of Surgery (MBBS), National University of Singapore
  • Member, Royal College of Surgeons of Edinburgh (MRCSEd)
  • Master of Medicine (Orthopaedic Surgery), National University of Singapore
  • Fellow, Royal College of Surgeons of Edinburgh, FRCSEd (Orthopaedic Surgery)
  • Clinical Hip and Sports Medicine Fellow, Orthopädische Chirurgie München (OCM), Germany

 

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Mount Elizabeth Novena Specialist Centre
38 Irrawaddy Road, #08-62/63
Singapore 329563
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Weekdays: 9.00am – 5.00pm
Saturdays: 9.00am – 1.00pm
Sundays and Public Holidays: Closed

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    Mount Elizabeth Novena Specialist Centre
    38 Irrawaddy Road, #08-62/63
    Singapore 329563

    Frequently Asked Questions (FAQ)

    What is the primary cause of shoulder impingement?

    Shoulder impingement is commonly caused by repetitive overhead activities, anatomical variations, muscle weakness, and age-related changes that lead to the narrowing of the space where the rotator cuff tendons are located.

    Can shoulder impingement heal on its own?

    While mild cases may improve with rest and non-surgical treatments, chronic or severe shoulder impingement typically requires a structured treatment plan for effective healing.

    How long does recovery from shoulder impingement take?

    The recovery time can vary widely depending on the severity of the condition and the chosen treatment method. Non-surgical treatments may offer relief within weeks to months, while recovery from surgery may take several months.

    Is physical therapy necessary for shoulder impingement?

    Yes, physical therapy is a key component of treating shoulder impingement. It focuses on strengthening the shoulder muscles, improving flexibility, and restoring normal shoulder mechanics.

    Can exercises worsen shoulder impingement?

    Certain exercises, especially those involving overhead movements, can exacerbate shoulder impingement. Consult your doctor before starting any exercise regimen.

    What can I do to prevent shoulder impingement?

    Prevention strategies include using proper techniques in sports and activities, engaging in regular strengthening and stretching exercises, making ergonomic adjustments, and maintaining good posture.