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 patient education resources, see the Hand, Wrist, Elbow, and Shoulder Center and Sports Injury Center, as well as Rotator Cuff Injury and Repetitive Motion Injuries.
