GeneHealth - Your precision medicine

Shoulder Impingement Syndrome

Disease Details

Family Health Simplified

Buy Membership

Description: Shoulder impingement syndrome occurs when the rotator cuff tendons are intermittently trapped and compressed during shoulder movements, leading to pain and restricted motion.
Type: Shoulder impingement syndrome is not typically classified as a genetic disorder. It is generally considered a condition arising from mechanical factors, such as repetitive overhead activities, poor posture, or anatomical variations that lead to the compression of the rotator cuff tendons and bursa in the shoulder. Therefore, it does not have a type of genetic transmission.
Signs And Symptoms: The most common symptoms in impingement syndrome are pain, weakness and a loss of movement at the affected shoulder. The pain is often worsened by shoulder overhead movement and may occur at night, especially when lying on the affected shoulder. The onset of the pain may be acute if due to an injury or insidious if due to a gradual process such as an osteoarthritic spur. The pain has been described as dull rather than sharp, and lingers for long periods of time, making it hard to fall asleep. Other symptoms can include a grinding or popping sensation during movement of the shoulder.The range of motion at the shoulder may be limited by pain. A painful arc of movement may be present during forward elevation of the arm from 60° to 120°. Passive movement at the shoulder will appear painful when a downward force is applied at the acromion but the pain will ease once the force is removed.
Prognosis: The prognosis for shoulder impingement syndrome is generally good with appropriate treatment. Most individuals respond well to conservative management, which includes rest, physical therapy, anti-inflammatory medications, and activity modification. In cases where these measures are not effective, corticosteroid injections or surgery may be required. Long-term outcomes are typically positive, especially if the condition is diagnosed early and managed properly. Regular follow-up and adherence to a rehabilitation plan can help prevent recurrence.
Onset: The onset of shoulder impingement syndrome often occurs gradually. It can develop due to repetitive overhead activities, shoulder injuries, or aging-related wear and tear on the shoulder joint.
Prevalence: The prevalence of shoulder impingement syndrome varies, but it is estimated that it affects approximately 7-27% of the general population at some point in their lives. It is one of the most common causes of shoulder pain.
Epidemiology: Shoulder impingement syndrome is a common condition. Regarding its epidemiology, the prevalence is higher in populations engaging in repetitive overhead activities, such as athletes (e.g., swimmers, throwers) and individuals in certain occupations (e.g., painters, construction workers). It often affects adults aged 40-60 but can occur in younger individuals, especially athletes. Overall, it is one of the leading causes of shoulder pain.
Intractability: Shoulder impingement syndrome is generally not considered intractable. With appropriate treatment, including rest, physical therapy, anti-inflammatory medications, and sometimes corticosteroid injections, many patients experience significant improvement. In more severe cases, surgical intervention may be necessary, but the condition is typically manageable with a structured treatment plan.
Disease Severity: Shoulder impingement syndrome can vary in severity. It ranges from mild, where it may cause discomfort or pain during certain activities, to severe, where it can significantly impair shoulder movement and function without intervention. In more severe cases, it may lead to chronic pain or even rotator cuff tears if left untreated. Treatment typically includes physical therapy, pain management, and in some cases, surgery.
Healthcare Professionals: Disease Ontology ID - DOID:14276
Pathophysiology: Shoulder impingement syndrome occurs when tendons or bursa in the shoulder become compressed during shoulder movements. This compression leads to irritation and inflammation, causing pain and limited movement. The primary structures involved are the rotator cuff tendons, particularly the supraspinatus tendon, and the subacromial bursa. Impingement typically happens due to narrowing of the subacromial space, which can be caused by factors like bony spur formation, tendon thickening, or poor shoulder mechanics. Repeated overhead activities can exacerbate the condition.
Carrier Status: Shoulder impingement syndrome is not a genetic condition, so there is no carrier status associated with it. It typically occurs due to repetitive overhead activities or degeneration of tendons in the shoulder.
Mechanism: The scapula plays an important role in shoulder impingement syndrome. It is a wide, flat bone lying on the posterior thoracic wall that provides an attachment for three different groups of muscles. The intrinsic muscles of the scapula include the muscles of the rotator cuff- the subscapularis, infraspinatus, teres minor and supraspinatus. These muscles attach to the surface of the scapula and are responsible for the internal and external rotation of the glenohumeral joint, along with humeral abduction. The extrinsic muscles include the biceps, triceps, and deltoid muscles and attach to the coracoid process and supraglenoid tubercle of the scapula, infraglenoid tubercle of the scapula, and spine of the scapula. These muscles are responsible for several actions of the glenohumeral joint. The third group, which is mainly responsible for stabilization and rotation of the scapula, consists of the trapezius, serratus anterior, levator scapulae, and rhomboid muscles and attach to the medial, superior, and inferior borders of the scapula. Each of these muscles has its own role in shoulder function and must be in balance with the others in order to avoid shoulder pathology.
Abnormal scapular function is called scapular dyskinesis. One action the scapula performs during a throwing or serving motion is elevation of the acromion process in order to avoid impingement of the rotator cuff tendons. If the scapula fails to properly elevate the acromion, impingement may occur during the cocking and acceleration phase of an overhead activity. The two muscles most commonly inhibited during this first part of an overhead motion are the serratus anterior and the lower trapezius. These two muscles act as a force couple within the glenohumeral joint to properly elevate the acromion process, and if a muscle imbalance exists, shoulder impingement may develop.
The scapula may also be misplaced if a rib deep to it is not moving correctly. Often in the case of Shoulder impingement syndrome, the scapula may be anteverted such that the shoulder on the affected side appears protracted. The ribs that may cause such an anteversion of the scapula include ribs 2–8.
Treatment: Impingement syndrome is usually treated conservatively, but sometimes it is treated with arthroscopic surgery or open surgery. Conservative treatment includes rest, cessation of painful activity, and physical therapy. Physical therapy treatments would typically focus at maintaining range of movement, improving posture, strengthening shoulder muscles, and reduction of pain. NSAIDs and ice packs may be used for pain relief.Therapeutic exercises might be favorable intervention compared to passive treatment approaches, electrotherapy and placebo. A recent meta-analysis done on rotator cuff tendinopathy has shown that nearly all types of active resistance training programs were proven to be effective in improving pain and shoulder function with no significant differences among the different exercise types, further cementing the favorability of a more active intervention over passive modalities when it comes to rotator cuff issues. Exercises may help to regain the scapulo-humeral rhythm and scapular control which may reduce pain.
Compassionate Use Treatment: Shoulder impingement syndrome, also known as subacromial impingement, involves the inflammation of tendons or bursa in the shoulder. This can lead to pain and restricted movement. Here are some treatment options, including compassionate use and off-label/experimental treatments:

**Compassionate Use Treatment:**
- Compassionate use treatments typically apply to severe or life-threatening conditions where standard treatments have failed. Shoulder impingement syndrome, being a non-life-threatening condition, generally doesn't qualify for compassionate use programs.

**Off-Label or Experimental Treatments:**
1. **Platelet-Rich Plasma (PRP) Therapy:**
- PRP involves injecting a concentration of the patient’s own platelets to accelerate the healing of injured tendons. It is experimental but has shown promise in treating tendinopathies.

2. **Botulinum Toxin (Botox) Injections:**
- Botox injections may be used off-label to manage pain and muscle spasms associated with shoulder impingement.

3. **Extracorporeal Shock Wave Therapy (ESWT):**
- ESWT is a non-invasive treatment that uses shock waves to promote healing. While commonly used for plantar fasciitis and tennis elbow, it is considered off-label for shoulder impingement.

4. **Stem Cell Therapy:**
- This involves injecting stem cells into the affected shoulder to promote tissue repair. This is still largely experimental.

5. **Ultrasound-Guided Barbotage:**
- This procedure involves the use of ultrasound to guide the removal of calcium deposits within the tendons. It is another off-label approach for calcific tendinitis within impingement syndrome.

Discuss these options with a healthcare provider to determine the best course of action for your specific condition.
Lifestyle Recommendations: For shoulder impingement syndrome, here are some lifestyle recommendations that may help alleviate symptoms and prevent further injury:

1. **Rest and Activity Modification**: Avoid activities that exacerbate the pain, especially those that involve lifting the arm overhead.
2. **Proper Posture**: Maintain good posture to reduce strain on the shoulder. When sitting, make sure your back is straight and shoulders are relaxed.
3. **Strengthening and Stretching Exercises**: Engage in regular exercises to strengthen the rotator cuff and shoulder muscles. Stretching exercises can help maintain flexibility.
4. **Ergonomic Adjustments**: Modify your workstation or activity setup to reduce shoulder strain. Ensure that you use proper techniques when lifting or performing repetitive tasks.
5. **Warm-Up and Cool-Down**: Always warm up before engaging in physical activity and cool down afterward to prepare and relax your muscles.
6. **Use of Anti-inflammatory Measures**: Applying ice packs to the shoulder can help reduce inflammation and pain. Over-the-counter anti-inflammatory medications may also be beneficial.
7. **Physical Therapy**: Consult a physical therapist for a tailored exercise program and manual therapy techniques.
8. **Healthy Weight Maintenance**: Keeping a healthy weight can reduce stress on joints, including the shoulder.
9. **Avoid Overuse**: Pacing activities and ensuring adequate rest can help prevent overuse injuries.

If symptoms persist, it's advisable to seek medical advice for potential further interventions.
Medication: For shoulder impingement syndrome, the main types of medication that may be prescribed include nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen to alleviate pain and reduce inflammation. Corticosteroid injections may also be administered directly into the shoulder to provide more significant relief in some cases. Always consult a healthcare professional for an appropriate treatment plan tailored to individual needs.
Repurposable Drugs: For shoulder impingement syndrome, repurposable drugs often include:

1. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen to reduce pain and inflammation.
2. Corticosteroid injections to decrease inflammation in the shoulder joint.
3. Analgesics such as acetaminophen to manage pain.
Metabolites: Shoulder impingement syndrome does not directly relate to specific metabolites. It is a condition where the tendons or bursa in the shoulder are compressed during arm movements, causing pain and limited mobility. Treatment typically focuses on reducing inflammation and restoring range of motion rather than targeting specific metabolites.
Nutraceuticals: There is limited evidence supporting the direct use of nutraceuticals specifically for shoulder impingement syndrome. However, certain supplements may help manage inflammation and support joint health, potentially benefiting those with this condition. These include:

1. **Omega-3 fatty acids** – Found in fish oil, they have anti-inflammatory properties.
2. **Turmeric (curcumin)** – Known for its anti-inflammatory benefits.
3. **Glucosamine and chondroitin** – Often used to support joint health.
4. **Vitamin D** – Plays a role in bone health and muscle function.
5. **Collagen supplements** – May support tendon and joint health.

Always consult a healthcare professional before starting any new supplement regimen.
Peptides: Peptides are small chains of amino acids that have been studied for their potential therapeutic effects in various conditions, including shoulder impingement syndrome. Research is ongoing to determine their effectiveness in promoting tissue repair and reducing inflammation.

Nanotechnology (nan) involves the use of nanoparticles to deliver drugs or therapeutic agents directly to affected tissues. In the context of shoulder impingement syndrome, nanotechnology could potentially enhance the delivery and effectiveness of treatments, such as anti-inflammatory drugs or regenerative therapies, by targeting the specific areas of inflammation and tissue damage.