What is secondary impingement syndrome?

Secondary impingement syndrome is characterized by pain in the shoulder due to inflammation of the tendons of the rotator cuff or the bursa (subacromial bursa). The rotator cuff is a series of four muscles that surround the ball of the shoulder (humeral head). A main function of the rotator cuff is to maintain the humeral head within the center of the glenoid. The subacromial bursa sits over the top of the cuff, allowing the cuff tendons to slide under the roof of the shoulder (acromion) without undue friction.

Normally, the humeral head gets closer to the acromion when the shoulder is moved, particularly as you reach overhead. Repeated throwing or overhead activities may cause fatigue of the rotator cuff muscles. This may lead to excessive motion of the humeral head within the glenoid, and the humeral head may slide upward and forward, closer to the acromion, with throwing and overhead activity. Thus, the inflammation or pain is due to injury or overuse of the rotator cuff and due to pinching of the rotator cuff and bursa between the humeral head and the acromion.

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How does secondary impingement syndrome occur?

• Overuse of the shoulder due to repetitive throwing or overhead activity
• Uncommonly, direct blow or injury to the shoulder

What increases the risk?

• Contact sports, such as football, wrestling or boxing
• Throwing sports, such as baseball, tennis or volleyball
• Swimming
• Weightlifting and bodybuilding
• Heavy labor
• Previous injury to rotator cuff, including impingement
• Poor physical conditioning (strength and flexibility)
• Loose ligaments or joints (“double jointed”)

What are the symptoms of secondary impingement syndrome?

• Pain around the shoulder, often at the outer portion of the upper arm
• Pain that is worse with shoulder function, especially when reaching overhead or lifting
• Occasionally, aching when not using your arm; possibly pain that awakens you at night
• Occasionally, tenderness, swelling, warmth or redness over the outer aspect of the shoulder
• Loss of strength
• Limited motion of the shoulder, especially when reaching behind or across your body
• Crepitation (a crackling sound) when the shoulder is moved
• Biceps tendon pain and inflammation (in the front of the shoulder), worse with bending the elbow or lifting

How is secondary impingement syndrome treated?

Non-operative treatment: Initial treatment consists of medication and ice to relieve the pain, stretching and strengthening exercises, and modification of the activity that initially caused the problem. These all can be carried out at home, although referral to a physical therapist or athletic trainer may be recommended. Treatment is geared toward the weak rotator cuff and shoulder blade muscles to help stabilize the shoulder. An injection of cortisone to the area around the tendon (within the bursa) is not usually  recommended.

Operative treatment: Surgery for this condition is rare. .  It is performed to tighten or stabilize the shoulder, not to relieve pressure on the rotator cuff. This is usually only considered after at least 6 months of conservative treatment. Surgery may be performed arthroscopically or through an open incision.

What are the complications of treatment?

• Possible complications of operative treatment include:

• Surgical complications not specifically associated with shoulder repair/reconstruction, such as pain, bleeding (uncommon), infection (<1percent), nerve injury (uncommon), stiffness, problems with anesthesia, and inability to return to previous level of pre-injury activity.

When can you return to your sport/activity?

This condition is usually curable if treated appropriately with conservative treatment and resting of the affected area. Return to full activity is usually possible four to six months after surgery.

How can secondary impingement syndrome be prevented?

• Appropriately warm up and stretch before practice or competition
• Allow time for adequate rest and recovery between practices and competition
• Maintain appropriate conditioning:
  • Cardiovascular fitness
  • Shoulder flexibility
  • Muscle strength and endurance
• Use proper technique