He subacromial impingement It is also known as subacromial impingement, compression or entrapment syndrome.
This is a pathology that occurs when the space between the acromion (structure located at the top of the scapula) and the humerus is reduced. The tendon of the supraspinatus muscle runs through this space and can become compromised or “pinched”, generating an initial inflammatory process and tendinosis in more advanced stages, which can lead to triggering symptoms in the patient.
However, this reduction of the subacromial space is not always the cause of shoulder pain, as this symptom is associated with a multifactorial and more complex origin. It is known that there are people with a reduction of this space who do not present any symptoms.
We also know that around 20-30% of the general population may experience subacromial impingement at some point in their life.
How do I know if I have a subacromial impingement? Symptoms.
In order to diagnose a subacromial impingement we must know the patient's medical history and symptoms.
Some of the most common symptoms are:
- Shoulder pain (usually in the upper and outer area): It is usually stabbing, internal, and intensifies when the arm is raised and separated. It often worsens when lying on the affected shoulder.
- Weakness and lack of strength: Usually when trying to lift or move objects.
- Rigidity and limitation: range of motion.
- Feeling of “trapping” or friction.
In addition, there are orthopedic tests such as the Neer test or the Hawkins-Kennedy test that can lead us to suspect a subacromial compression syndrome. However, their low specificity can give false positives and they do not confirm the diagnosis on their own.
Finally, the imaging test par excellence, to be able to determine if this reduction of the subacromial space is causing the supraspinatus tendon or if an inflammation of the bursa could be occupying this space, is the ultrasound. The ultrasound will allow us to perform dynamic tests of the shoulder, at the time, without radiation and at a lower cost than other imaging tests.
Treatment of subacromial compression syndrome: Surgical or conservative?
A few years ago, treatment for subacromial impingement was surgical, however, today with advances in physiotherapy and an appropriate approach, many patients can avoid surgery.
In this case, conservative physiotherapy treatment will involve a series of techniques such as manual therapy, radiofrequency, neuromodulation, postural work and therapeutic exercise. Joint mobility and motor control are key in the rehabilitation of any shoulder injury. In this process, education about pain will be important (knowing how to distinguish between muscular pain and the acute pain caused by the injury).
The goal of physical therapy treatment for subacromial impingement pathology will be to reduce pain, improve shoulder function, and prevent relapse.
If you feel pain, it is important to seek the help of a trusted physiotherapist as soon as possible to prevent the injury from developing unfavourably and to ensure a quick and optimal recovery.
How long will it take to recover from shoulder impigment?
As always, the time will vary depending on the patient (age, extent of damage to the injured tissue, activities performed, etc.) and the treatment chosen.
If the treatment of choice is conservative, we are talking about a process that can last from 3-6 weeks in acute cases to 4-5 months in more severe cases. If the patient has had to undergo surgery, the time for complete recovery will be longer.
Should I stop playing sports if I have shoulder impingement syndrome?
The answer to this question will depend on the sporting gesture the patient wants to perform. If the sport he or she practices involves more arms than legs, we must reduce and adapt any gesture that reproduces the pain. Overhead movements can aggravate these symptoms.
Ideally, you should have a trusted sports physiotherapist who can establish a specific exercise plan for the injury and the patient who suffers from it. At our Evolution physiotherapy clinic in Alcalá de Henares, we have the best experts in musculoskeletal injuries.
Are corticosteroid injections recommended for subacromial impingement injuries?
Corticosteroids could be of interest in reducing pain and inflammation. However, our opinion is that, before resorting to them, we should opt for the use of physiotherapy, with its different analgesic and anti-inflammatory tools, in addition to therapeutic exercise with the aim of recovering function.
In our center Evolution physiotherapy we have high technology to be able to address this type of pathology, as well as non-specific shoulder pain.
In conclusion to this post, we can say that, in a simplistic way, there are a large number of patients diagnosed with subacromial impingement who are recommended surgery (acromioplasty), without having reached an adequate diagnosis of their pain and based on a purely mechanical fact (the friction of the acromion on its tendons is producing the symptoms). As Dr. Santiago Arauz explains in the following video, many other factors are known to influence shoulder pain.
