eMedicine Specialties > Sports Medicine > Shoulder

Shoulder Impingement Syndrome: Follow-up

Author: Thomas M DeBerardino, MD, Associate Professor of Orthopaedic Surgery, University of Connecticut Health Center
Coauthor(s): Wing K Chang, MD, Musculoskeletal Spine Fellow, Department of Physical Medicine and Rehabilitation, University of Michigan Medical Center
Contributor Information and Disclosures

Updated: Aug 13, 2009

Follow-up

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.

Miscellaneous

Medicolegal Pitfalls

  • No immediate catastrophic sequela exists if diagnosis of shoulder impingement syndrome or rotator cuff tear is missed; however, the patient may become disabled progressively without prompt and correct diagnosis and treatment. 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 medications. With complaint of any shoulder pain, the clinician must rule out disorders (eg, infection, tumor, dislocation, fracture, vascular injury, peripheral neurologic injury, cervical spine neurologic injury) that may have catastrophic consequences if action is not taken immediately. These diagnoses must be kept in mind in the differential and tested when assessing a shoulder problem in any patient.

Special Concerns

  • Shoulder impingement syndrome is managed similarly in all populations. How aggressive the management of this syndrome is depends upon the patient's activity level, reliance on the shoulder for occupation/athletics (recreational or competitive), age, and comorbid medical illnesses.
  • In pregnancy, nursing mothers, young children, and patients with comorbid medical illnesses, caution must be used when administering medication to ensure the chosen medication is compatible for the patient.
  • Patient's age, medical illnesses, low activity level, poor healing potential, poor anesthetic candidate, and pregnancy status may preclude the patient from being a surgical candidate.
 


More on Shoulder Impingement Syndrome

Overview: Shoulder Impingement Syndrome
Differential Diagnoses & Workup: Shoulder Impingement Syndrome
Treatment & Medication: Shoulder Impingement Syndrome
Follow-up: Shoulder Impingement Syndrome
References
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References

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Further Reading

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Keywords

shoulder impingement syndrome, rotator cuff impingement, subacromial impingement, supraspinatus impingement, subacromial bursitis

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Contributor Information and Disclosures

Author

Thomas M DeBerardino, MD, Associate Professor of Orthopaedic Surgery, 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. Honoraria Speaking and teaching; Genzyme Biosurgery. Inc. Grant/research funds Other; Musculoskeletal Transplant Foundation Grant/research funds Other; Histogenics Grant/research funds None; Arthrex, Inc. Consulting fee Speaking and teaching

Coauthor(s)

Wing K Chang, MD, Musculoskeletal Spine Fellow, Department of Physical Medicine and Rehabilitation, University of Michigan Medical Center
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.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, 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, Sports Medicine Fellowship Director, 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, Phi Beta Kappa, and Wilderness Medical Society
Disclosure: Nothing to disclose.

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