YOUR HEALTH:
SPORTSMEDICINE UPDATE
By Dr. Robert Martin
Shoulder Impingement
One of the most common complaints in any orthopaedic practice is
shoulder pain. The most common cause of shoulder pain is problems
related to a complex structure know as the rotator cuff. The rotator
cuff is commonly injured in overhead or throwing sports and thus gets
mentioned regularly in the sports media. If you doubt this theory just
watch Sports Center for one week and I can almost guarantee a reference
to someone’s injured rotator cuff. Last year alone Greg Norman, Pete
Sampras, 3 MLB pitchers and many more all had significant rotator cuff
injuries, some requiring surgery. So why is this so common. It has to
do with two factors, one is the design of some shoulders and the other
is the way we use our shoulders.
The shoulder starts with the scapula
or shoulder blade which is suspended on the back by 21 muscles (the
only bone connecting the scapula to the body is the clavicle or
collarbone). Articulating in a shallow socket in the scapula (called
the glenoid) is the humerus or arm bone. The fact that the glenoid is
shallow (about the curve of a coffee cup saucer) allows to arm to move
through a wide and free ranging motion pattern. Off the back of the
scapula is a projection of bone that forms a hood over the shoulder
joint. This bone is called the acromion. Three muscles that begin on
the scapula form a common tendon which is the rotator cuff attaching to
the humerus. A major portion of the rotator cuff passes directly
underneath the acromion. In doing so the rotator cuff is protected yet
in another way it is confined and at times compressed as the arm moves
above shoulder height. This compression of the rotator cuff between the
humeral head and the acromion is known as Impingement Syndrome and
results in progressive wear even tearing of the rotator cuff tendon. In
most people this process starts with mild symptoms of shoulder pain
many times coming and going over months or years. Typically this pain
is worse with reaching above shoulder height, reaching behind the back
or lying on the shoulder. Often this is referred to as bursitis.
Impingement is more likely to occur in people with a particular shape
to their acromions. Acromions that are flat rarely cause problems
however acromions that are curved down in the front compress the
rotator cuff more resulting in impingement.
Solutions for this problem
generally start with limiting overhead activities and taking an
anti-inflammatory for a few weeks. If this does not get results an
evaluation by your physician may be warranted. Additional medical
treatment and physical therapy may be recommended. In some cases
surgery is needed if the injury to the rotator cuff is significant.
Surgery is generally done arthroscopically through small poke hole type
incisions as an outpatient. The surgery relieves the pressure on the
rotator cuff and alleviates pain by removing the hook portion of the
acromion. Arthroscopy patients can generally return to normal daily
activities rapidly.