What is shoulder impingement?

What is shoulder impingement?

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Shoulder impingement, also known as subacromial impingement, is a common cause of shoulder pain that occurs when the structures in the shoulder joint become compressed or irritated. It typically involves the compression of the tendons of the rotator cuff and the subacromial bursa (a fluid-filled sac that reduces friction between tendons and bones). Shoulder impingement can lead to pain, limited range of motion, and functional limitations.

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The shoulder joint is a ball-and-socket joint where the upper arm bone (humerus) meets the shoulder blade (scapula). The space between the humerus and the acromion (a bony projection of the scapula) is called the subacromial space. This space is important for the smooth movement of the shoulder. However, when this space narrows, the structures within it can become compressed or pinched, resulting in shoulder impingement.

Common symptoms of shoulder impingement

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The common symptoms of shoulder impingement include:

1. Pain: The primary symptom is pain in the shoulder, typically felt in the front or outer part of the shoulder. The pain may be a localized, sharp, dull aching and may worsen with overhead activities or reaching behind the back.
2. Limited range of motion: Individuals with shoulder impingement may experience difficulty raising the arm overhead or reaching behind the back. There may be a loss of flexibility and a feeling of stiffness in the shoulder.
3. Weakness: Impingement can lead to weakness of the muscles surrounding the affected shoulder, making it challenging to perform activities that require strength, such as lifting or carrying objects.
4. Clicking or popping: Some individuals may experience clicking, popping, or snapping sensations in the shoulder during certain movements.

What causes shoulder impingement?

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The cause of shoulder impingement is multifactorial, involving both structural and mechanical impairments. Causes and risk factors for shoulder impingement include:

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1. Repetitive overhead activities: Activities that involve excessive or repetitive overhead movements that load the shoulder joint, such as throwing, swimming, or overhead lifting, can put strain on the structures of the shoulder and contribute to impingement.
2. Impaired posture: Rounded shoulders, and forward head posture can reduce the space in the subacromial area, decreasing its mobility and increasing the risk of impingement. Faulty upper body posture leads to an imbalance in the length and strength of the shoulder and upper back musculature and decreases the effectiveness of the dynamic and stabilizing structures of the shoulder joint. 
3. Muscle imbalances: Weakness or imbalance in the muscles around the shoulder, particularly the rotator cuff muscles and the scapular stabilizers, can affect shoulder mechanics and lead to impingement.
4. Structural abnormalities: Some individuals may have structural variations that predispose them to shoulder impingement, such as a hooked acromion shape or bony spurs.

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How can physical therapy help? 

Physical therapy is often a primary component of non-surgical treatment for shoulder impingement. The goals of physical therapy for shoulder impingement include:

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1. Pain and inflammation reduction: Physical therapists can utilize different modalities such as cryotherapy, hot moist pack, ultrasound, and electrical stimulation to the site of the lesion to help reduce pain and inflammation. Low intensity cross-fiber or friction massage may also be applied. In some cases, the use of arm sling is required to support the area and allow it to rest. 
2. Restoring range of motion: Physical therapists prescribe different mobilization techniques and stretching exercises  to improve shoulder mobility and flexibility. 
3. Strengthening exercises: Strengthening the muscles of the shoulder and upper back areas, specifically the rotator cuff muscles and scapular stabilizers are important to develop stability and balance in strength of all the shoulder and scapular muscles within its range and tolerance.  
4. Posture correction: Postural awareness and correction techniques are prescribed by the physical therapists. Developing patient awareness of balanced posture and its effects are important for patients with impingement syndrome, as faulty posture can be a cause of this condition. Supportive techniques such as shoulder strapping and or scapular taping and mirrors can be used for reinforcement. 
5. Functional training: Specificity of training toward the desired functional outcomes begins as soon as the patient has developed control of posture. The physical therapists prescribe exercises that simulate functional activities to help patients regain functional abilities of the shoulder, such as overhead reaching, lifting, or throwing, without pain or limitation.
6. Education and home exercise program: Physical therapists can educate patients about safe and effective execution of their home exercise program, and modifying activities or using proper techniques to prevent further shoulder irritation and impingement. They also encourage patients' adherence to the program and avoid irritating the healing tissues.

It's important to consult with a healthcare professional, such as a doctor or physical therapist, for an accurate diagnosis and appropriate management plan for shoulder impingement. The treatment approach may vary depending on the severity of the condition and individual factors.

Trust PeteHealth for shoulder impingement treatment

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