Prolonged Shoulder Impingement Syndrome Leads to Rotator Cuff Tear

If you have had shoulder pain in currently or in the past, you may have heard the term, "Impingement Syndrome."  This is a diagnosis which usually refers to the Subacromial Space in the shoulder and is known in the medical community as, "Subacromial Impingement Syndrome."  Why is this called the Subacromial Space you may ask?  This is because it is located below a bone in the shoulder known as the Acromion.  What happens with Impingement Syndrome is that due to altered anatomic structures and/or poor biomechanics, two tendons and one bursa become pinched by the Acromion during shoulder movement.  The two tendons that can be involved are the Supraspinatus Tendon and the Long Head of the Biceps Brachii Tendon.  The Supraspinatus tendon is one of four rotator cuff muscles in the shoulder and if left untreated can result in a partial to full thickness tear in the Rotator Cuff.  For more information on the shoulder Rotator Cuff anatomy click here.  The Long Head of the Biceps Brachii Tendon is an extension of the Biceps muscle and can also be torn due to chronic Impingement Syndrome.  Finally, the bursa that may be affected during Impingement Syndrome is known as the Subacromial Bursa.

Subacromial Impingement Syndrome has three stages according to Charles Neer.  Stage 1 is described as having acute but reversible edema and inflammation to the Supraspinatus and Long Head of the Biceps Brachii Tendons.  It is typically seen in individuals who are less than 25 years of age.  The important part of this Stage is that the effects are REVERSIBLE.  When a person has reached Stage 2 which is between ages 25-40, fibrotic changes have begun to happen in the affected tendons and/or bursa.  This is significant because these affected structures are no longer as pliable and strong as they once were, thus increasing the chances of tearing.  Finally Stage 3 occurs in individuals who are typically older than 40 years of age and have had a long history of shoulder pain.  These individuals will have partial to full thickness tears in their Supraspinatus and/or Long Head of Biceps Brachii Tendons.  The moral of this: DO NOT LET IT PROGRESS TO STAGE 3!  If you suspect you have Impingement Syndrome get yourself treated.  A rehabilitation protocol that emphasizes normal shoulder biomechanics, scapular and rotator cuff strengthening has been proven in the research community to relieves symptoms.  You can read more about the research here.

For more information on Subacromial Impingement Syndrome check out our website here.

Examples of exercises for Subacromial Impingement Syndrome can be found below: