Shoulder Impingement Syndrome Follow-up

Author: Thomas M DeBerardino, MD; Chief Editor: Craig C Young, MD more...

Updated: Jan 20, 2010

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Return to Play
Complications
Prevention
Prognosis
Education
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Return to Play

Return to play is restricted until full pain-free ROM is restored, both rest and activity-related pain are eliminated, and provocative impingement signs are negative. Isokinetic strength testing must be 90% compared to the contralateral side. When the patient is symptom-free, resuming activities is gradual, first during practice to build up endurance while working on modified techniques/mechanics, and then in simulated game situations. The athlete should continue flexibility and strengthening exercises after returning to his/her sport to prevent recurrence.

Complications

If shoulder impingement syndrome is not diagnosed and treated promptly and correctly, it can progress to rotator cuff degeneration and eventual tear. Other complications may include progression to adhesive capsulitis, cuff tear arthropathy, and reflex sympathetic dystrophy. Complications also may result from surgery, injection, physical therapy, or medication.

Prevention

Primary prevention should be considered an integral part in the treatment of impingement syndrome. Education of patients at risk can do much to circumvent the development of impingement syndrome. Athletes, particularly those involved in throwing and overhead sports, and laborers with repetitive shoulder stress should be instructed in proper warm-up techniques, specific strengthening techniques, and have a good understanding of the warning signs of early impingement.

Prognosis

In general, prognosis for prompt and correct diagnosis and treatment of shoulder impingement syndrome is good and 60-90% of patients improve and are symptom-free with conservative treatment. Surgical outcomes are promising in patients who fail conservative therapy.

Education

Patient education may improve the outcome if the patient is educated regarding avoidance of provocative activities, pathology, and proper shoulder arthrokinematics. Education also should stress proper warm-up techniques, specific strengthening techniques, and warning signs of early impingement. A proper home exercise program should be formulated and encouraged to prevent recurrence of symptoms.

For excellent patient education resources, visit eMedicine's Hand, Wrist, Elbow, and Shoulder Center and Sports Injury Center. Also, see eMedicine's patient education article Rotator Cuff Injury and Repetitive Motion Injuries.

Contributor Information and Disclosures

Author

Thomas M DeBerardino, MD Associate Professor, Department of Orthopedic Surgery, Consulting Surgeon, Sports Medicine, Arthroscopy and Reconstruction of the Knee, Hip and Shoulder, Team Physician, Orthopedic Consultant to UConn Department of Athletics, University of Connecticut Health Center

Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, and American Orthopaedic Society for Sports Medicine

Disclosure: Arthrex, Inc. Grant/research funds Other; Arthrex, Inc. Consulting fee Speaking and teaching; Genzyme Biosurgery. Inc. Grant/research funds Other; Musculoskeletal Transplant Foundation Grant/research funds Other; Histogenics Grant/research funds None

Coauthor(s)

Wing K Chang, MD Physician, Peachtree Orthopaedic Clinic

Wing K Chang, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Specialty Editor Board

Andrew D Perron, MD Residency Director, Department of Emergency Medicine, Maine Medical Center

Andrew D Perron, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jon B Whitehurst, MD Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Director of Primary Care Sports Medicine Fellowship, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

References

Neer CS 2nd. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am. Jan 1972;54(1):41-50. [Medline].
Bigliani LU, Morrison DS, April EW. The morphology of the acromion and rotator cuff: importance. Orthopedic Trans. 1986;10:228.
Santamato A, Solfrizzi V, Panza F, et al. Short-term effects of high-intensity laser therapy versus ultrasound therapy in the treatment of people with subacromial impingement syndrome: a randomized clinical trial. Phys Ther. Jul 2009;89(7):643-52. [Medline].
Dorrestijn O, Stevens M, Winters JC, van der Meer K, Diercks RL. Conservative or surgical treatment for subacromial impingement syndrome? A systematic review. J Shoulder Elbow Surg. Jul-Aug 2009;18(4):652-60. [Medline].
[Best Evidence] Ketola S, Lehtinen J, Arnala I, et al. Does arthroscopic acromioplasty provide any additional value in the treatment of shoulder impingement syndrome?: a two-year randomised controlled trial. J Bone Joint Surg Br. Oct 2009;91(10):1326-34. [Medline].
Andrews JR, Harrelson GL, Wilk KE. Physical Rehabilitation of the Injured Athlete. 2^nd ed. Philadelphia, Pa: WB Saunders Co; 1998:478-553.
Boyles RE, Ritland BM, Miracle BM, et al. The short-term effects of thoracic spine thrust manipulation on patients with shoulder impingement syndrome. Man Ther. Aug 2009;14(4):375-80. [Medline].
Brotzman SB. Clinical Orthopaedic Rehabilitation. St. Louis, Mo: Mosby; 1996:92-98.
Doiron Y, Delacroix S, Denninger M, Simoneau M. Kinetic strategies of patients with shoulder impingement syndrome. J Orthop Res. Jul 7 2009;epub ahead of print. [Medline].
Fu FH. Stone DA, ed. Sports Injuries: Mechanisms, Prevention, Treatment. Pittsburgh, Pa: Lippincott Williams & Wilkins; 1994:895-923.
Hawkins RJ, Kennedy JC. Impingement syndrome in athletes. Am J Sports Med. May-Jun 1980;8(3):151-8. [Medline].
Ho CY, Sole G, Munn J. The effectiveness of manual therapy in the management of musculoskeletal disorders of the shoulder: a systematic review. Man Ther. Oct 2009;14(5):463-74. [Medline].
Miller MD, Cooper DE, Warner JJ. Review of Sports Medicine and Arthroscopy. First ed. Philadelphia, Pa: WB Saunders Co; 1995:113-164.
Perez-Palomares S, Olivan-Blazquez B, Arnal-Burro AM, et al. Contributions of myofascial pain in diagnosis and treatment of shoulder pain. A randomized control trial. BMC Musculoskelet Disord. Jul 24 2009;10:92. [Medline]. [Full Text].
Youm T, Hommen JP, Ong BC, Chen AL, Shin C. Os acromiale: evaluation and treatment. Am J Orthop. Jun 2005;34(6):277-83. [Medline].

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