Shoulder Impingement Syndrome

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If you are experiencing sharp, pinching, or grabbing pain within the shoulder during overhead activities, or from putting your hands either behind your back or head, then you might be suffering from shoulder impingement syndrome!

Shoulder impingement syndrome is a condition where your shoulders rotator cuff tendons are intermittently trapped and compressed during shoulder movements. This causes injury to the shoulder tendons and bursa resulting in painful shoulder movements.  Impingement (impact on bone into rotator cuff tendon or bursa) should not occur during normal shoulder function. When it does happen, the rotator cuff tendon becomes inflamed and swollen, causing rotator cuff tendonopathy and if the bursa becomes inflamed, shoulder bursitiswill develop.  Both these conditions can co-exist or be present independently.

What Causes Shoulder Impingement Shoulder Pain?

Shoulder impingement has primary (structural) and secondary (posture & movement related) causes.

Primary rotator cuff impingement is caused by structural narrowing.  Some of us are born with a smaller sub-acromial space or conditions such as osteoarthritis can cause the growth of sub-acromial bony spurs, which further narrows the space.  Because of this structural narrowing, you are more likely to squash, impinge and irritate the soft tissues in the sub-acromial space, which results in bursitis or shoulder tendinopathy.

Secondary rotator cuff impingement is from dynamic instability. Impingement can occur if you have a dynamically unstable shoulder. This means that there is a combination of excessive joint movement, ligament laxity and muscular weakness around the shoulder joint. This impingement usually occurs over time due to repetitive overhead activity, trauma, previous injury, poor posture or inactivity.  In an unstable shoulder, the rotator cuff has to work harder, which can cause injury. An overworking rotator cuff fatigues and eventually becomes inflamed and weakens due to pain inhibition or tendon tears.  When your rotator cuff fails to work normally, it is unable to prevent the head of the humerus (upper arm) from riding up into the sub-acromial space, causing the bursa or tendons to be squashed. Failure to properly treat this instability causes the injury to recur. Poor technique or bad training habits such as training too hard is also a common cause of overuse injuries.

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What are the Symptoms of Shoulder Impingement?

Commonly rotator cuff impingement has the following symptoms:

  • An arc of shoulder pain approximately when your arm is at shoulder height and/or when your arm is overhead.
  • Shoulder pain that can extend from the top of the shoulder to the elbow.
  • Pain when lying on the sore shoulder.
  • Shoulder pain at rest as your condition deteriorates.
  • Muscle weakness or pain when attempting to reach or lift.
  • Pain when putting your hand behind your back or head.
  • Pain reaching for the seat-belt.

Who Suffers Shoulder Impingement?

Impingement syndrome is more likely to occur in people who engage in physical activities that require repeated overhead arm movements, such as tennis, golf, swimming, weight lifting, or throwing a ball. Occupations that require repeated overhead lifting or work at or above shoulder height are also at risk of rotator cuff impingement.

How is Shoulder Impingement Diagnosed?

Shoulder impingement is best diagnosed using clinical observations.  Orthopedic tests and scapula or humeral head correction techniques can be used to decrease or abolish pain.  Ultrasound scan can be useful to detect any associated injuries such as shoulder bursitis, rotator cuff tears, calcific tendonitis or shoulder tendinopathies.

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Shoulder Impingement Treatment

There are many structures that can be injured in rotator cuff impingement. How the impingement occurred is the most important question to answer. This is especially important if the onset was gradual since your static and dynamic posture, muscle strength, flexibility and spine shape all have important roles to play.

Once you suspect any rotator cuff injury, it is important to confirm the exact type of your rotator cuff injury since treatment does vary depending on the specific or combination of rotator cuff injuries.

Your rotator cuff is an important group of control and stability muscles that maintain “centralisation” of your shoulder joint. In other words, it keeps the shoulder ball centred over the small socket. This prevents injuries such as impingement, subluxations and dislocations.

We also know that your rotator cuff provides subtle glides and slides of the ball joint on the socket to allow full shoulder movement. Plus, your shoulder blade (scapula) has a vital role as the main dynamically stable base plate that attaches your arm to your chest wall.

Researchers have concluded that there are essentially 7 stages that need to be covered to effectively rehabilitate these injuries and prevent recurrence.

These are:

  • Early Injury: Protection, Pain Relief & Anti-inflammatory Treatment
  • Regain Full Shoulder Range of Motion
  • Restore Scapular Control and Scapulohumeral Rhythm
  • Restore Normal Neck-Scapulo-Thoracic-Shoulder Function
  • Restore Rotator Cuff Strength
  • Restore High Speed, Power, Proprioception and Agility Exercises
  • Return to Sport or Work