Shoulder Impingement: Treatment, Cost and Side Effects

Shoulder impingement is the impingement of the tendons of the shoulder with the shoulder blade. This results in persistent pain in the shoulder area and hinders the use of shoulder to reach overhead or to lift up hands. It is usually caused by repetitive activities of the shoulder joint such as swimming, painting and lifting. The condition when prolonged and untreated can lead to inflammation of the rotator cuff. The inflammation causes into tendonitis or the inflammation of the tendons and bursitis or the inflammation of the bursa. The rotator cuff muscles are the muscles which are responsible for the movement of the shoulder. The shoulder blade is called the acromion. The repetitive activity of the shoulder blade causes the rotator cuff and the acromion to rub against each other and narrow the space between them. This leads to shoulder impingement. The typical symptoms of shoulder impingement include extreme pain when moving shoulders, difficulty in raising hands, difficulty in reaching backwards and weakness of shoulders. In some cases, the tendons are often torn down and this leads to severe weakness in the hands. It is almost impossible for the person to raise hands or to lift anything with the hands. The treatment is usually diagnosed by the imaging devices which reveal changes in the structure of the bone. After the possibility of the arthritis is ruled by X-ray, usually, ultrasound is conducted to produce the images of the shoulder bone and the muscles surrounding the area. If the damage to the rotator muscles is severe, then MRI can also be conducted by the doctor to view the deformities in the bone and the tear of the tendons. After diagnosis, a plan for rehabilitation is formulated by the doctor which usually contains anti-inflammatory medications, physiotherapy and rest. If the damage to the tendons is serious, surgery may be advised.

The treatment is usually composed of rest and physical exercises to strengthen the muscles of the area. Medications to reduce inflammation are also accompanied by other treatments. If the other treatments do not produce any result, then surgery is the last resort to palliate the pain.

1. Self-care: After the diagnosis is confirmed, it is essential to take adequate rest for a few days to let the shoulder muscles and the joint to heal completely. All kinds of strenuous activities must be avoided at this stage of the treatment. One can use a sling to help the shoulder to remain in shape. However, it is not advised to completely restrict all movements as it will cause the shoulder to freeze permanently. Apart from this, ice packs are also found beneficial in reducing the swelling of the area of the shoulder. Ice packs can be applied to the area where the pain is experienced for about 15 minutes few times a day.
2. Physical Therapy: Restricting the movements of the shoulder completely can lead to weak shoulder muscles and freezing up of the shoulder. To prevent this from happening, light exercises are performed under the supervision of the doctor. These exercises will primarily be aimed at the muscles of shoulder, arm and chest. These exercises restore the strength and flexibility of the shoulder muscles and prevent the shoulder from freezing up. The exercises should not cause pain as they will not aggravate the condition. Thus, it is essential to perform these in moderation. A physiotherapist or an orthopaedic is usually involved in the treatment of the shoulder impingement. The physiotherapist advises some exercises which target the muscles of the shoulder. Some of the exercises recommended to perform during shoulder impingement are shoulder squeezes, shoulder stretching and range of motion exercises. These exercises are helpful in strengthening the rotator cuff muscles and the maintaining the flexibility of the shoulder joint. However, these exercises should be immediately stopped so as not to worsen the situation.
3. Medication: Although there are no medications specified for this condition, oral anti-inflammatory medications are prescribed to reduce and control the inflammation. Commonly used anti-inflammatory medicines are aspirin, naproxen or ibuprofen. The medication routine is usually followed for six to eight weeks which the time required to reduce the inflammation. Doctors advice must be taken while the treatment as the shoulder impingement if left untreated can lead to tendonitis and bursitis. In serious cases, where the medications and physiotherapy do not provide any relief, another alternative is to inject the patient with the corticosteroid injections. The corticosteroid injections are extremely effective in reducing the inflammation of the shoulder area. However, they have few side-effects and are used as a last resort when no relief is experienced otherwise.

The people who are at high risk of developing the disorder are athletes. The sports which require overhead and repetitive motion of shoulder are known to develop the disorder. The sports are swimming, tennis and baseball. A heavy load to shoulder also leads to the development of the disorder. Some of the occupations which put a heavy load on the shoulder are construction work and box movers. Painting is also known to cause shoulder impingement. However, these are possibilities and there are no specific eligibilities for this treatment until and unless it is at the surgery stage.

Any person who has developed shoulder impingement and not undergoing other physiotherapy treatments are eligible for the treatment.

The side-effects are usually caused by the intake of the anti-inflammatory medicines. The common side-effects are an upset stomach, indigestion, headaches and internal bleeding. Long-term use of medication can lead to internal bleeding, indigestion, constipation, vomiting, thinning of the skin and change in the blood pressure of the patient. The corticosteroid injections are usually linked to produce such side-effects to the patient.

After the treatment, it is generally advised to prohibit indulging in activities which require vigorous movement of the shoulder. A lot of rest is advised with the medications to reduce inflammation. Diet rich in protein is recommended. Medications may be stopped but shoulder exercises are continued. It is recommended to develop a routine of shoulder exercises on a daily basis. This helps in reducing the chances of narrowing the gap between the shoulder bone and the tendons again. It also helps in keeping the rotator cuff muscles strong and flexible.

The time in which the shoulder heals is different for different individuals. It depends on the extent of the condition. Generally, it takes about three months to six months to recover completely. The usual activity requires about two to four weeks of time for recovery. If the condition is diagnosed early, then the patient might show significant recovery in the first week itself. However, if the impingement if serious, then the parent might take months to recover. In some cases, no recovery is witnessed and then surgery is carried out. Patience is the key here. Overdoing the exercises to hasten recovery will only worsen the situation. The results of the treatment are long-lasting. However, if the patient is an athlete and is involved in the repetitive use of the shoulder, then it is advised to periodically visit the physiotherapist. An athlete should also be mindful while playing.

A typical session of physiotherapy costs around Rs 500 to Rs 1000. In rare cases, surgery is performed. The two alternatives to surgery are minimally invasive arthroscopic surgery and the traditional open surgery. The surgery is costlier and starts from Rs 1.5 lakhs to Rs 3 lakhs. The cost of the surgery varies with different hospitals and it usually depends on the organization, the kind of the surgery and the experience of the doctors.

If proper medications and physical exercises are done, then the impact of the treatment may stand long.

In extreme cases, surgery is the only option to stop the further worsening of the disease. The objective of the surgery is to widen the space between the rotator cuff muscles and the shoulder blade. The surgery can be minimally invasive arthroscopic surgery or it can be traditional open surgery requisite in the advanced cases. Arm slings are used for a short period to facilitate the recovery of the rotator cuff muscles and shoulder bone.