Shoulder Impingement syndrome
What is shoulder impingement syndrome?
Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). The group of muscles and tendons that we use to lift the arm up overhead are called the rotator cuff. The rotator cuff is sandwiched between the humerus and the top of the shoulder (acromion). There is also a lubricating sac called a bursa between the rotator cuff and the acromion. The bursa allows the tendons to glide freely when you move your arm.
When you raise your arm to shoulder height, the space between the acromion and rotator cuff narrows. The acromion can rub against (or "impinge" on) the tendon and the bursa, causing irritation and pain. This is called shoulder impingement syndrome.
Impingement should not occur during normal shoulder function. Over time, impingement can lead to inflammation and swelling of the rotator cuff tendon, a condition called rotator cuff tendonitis. Likewise if the bursa becomes inflamed, shoulder bursitis will develop. These conditions can co-exist or be present independently.
Common Causes
Shoulder impingement has primary (structural narrowing) and secondary (posture & movement related) causes.
Primary Rotator Cuff Impingement – Some of us are born with a smaller sub-acromial space. Conditions such as osteoarthritis can also 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 rotator cuff tendons.
Secondary Rotator Cuff Impingement – This is the most common type of impingement and usually occurs over time due to repetitive overhead activity, trauma, previous injury, poor posture or inactivity. When your rotator cuff is weak and 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.
Shoulder impingement syndrome is common in both young athletes and middle-aged people. Young athletes who use their arms overhead for swimming, baseball, and tennis are particularly vulnerable. Those who do repetitive lifting or overhead activities using the arm, such as construction or painting are also susceptible. Impingement can also be caused by poor posture such as hunched shoulders.
Signs & Symptoms
With impingement syndrome, pain is persistent and affects everyday activities. The typical symptoms of impingement include difficulty reaching up behind the back, pain with overhead use of the arm and weakness of shoulder muscles. Rotator cuff pain can also cause local swelling and tenderness in the front of the shoulder.
Some more commonly seen symptoms of impingement are the following:
Treatment
1. Rest - Avoid any repetitive reaching or overhead activities. Listen to your body, if something hurts - don't do it!
2. Anti-inflammatory meds - Ask your family doctor or pharmacist if it is safe for you to take anti-inflammatory medications such as ibuprofin.
3. Ice - If your shoulder is swollen and warm to touch, ice the area for 10-15 minutes at a time. Make sure you put a cloth between the ice and your skin and wait another hour before icing again.
3. Exercises and stretches:
Posture is very important! You should constantly be thinking about your posture and avoiding letting your shoulders fall forward. Try doing shoulder rolls and scapular retractions throughout the day to promote good posture.
Your shoulder is made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). The group of muscles and tendons that we use to lift the arm up overhead are called the rotator cuff. The rotator cuff is sandwiched between the humerus and the top of the shoulder (acromion). There is also a lubricating sac called a bursa between the rotator cuff and the acromion. The bursa allows the tendons to glide freely when you move your arm.
When you raise your arm to shoulder height, the space between the acromion and rotator cuff narrows. The acromion can rub against (or "impinge" on) the tendon and the bursa, causing irritation and pain. This is called shoulder impingement syndrome.
Impingement should not occur during normal shoulder function. Over time, impingement can lead to inflammation and swelling of the rotator cuff tendon, a condition called rotator cuff tendonitis. Likewise if the bursa becomes inflamed, shoulder bursitis will develop. These conditions can co-exist or be present independently.
Common Causes
Shoulder impingement has primary (structural narrowing) and secondary (posture & movement related) causes.
Primary Rotator Cuff Impingement – Some of us are born with a smaller sub-acromial space. Conditions such as osteoarthritis can also 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 rotator cuff tendons.
Secondary Rotator Cuff Impingement – This is the most common type of impingement and usually occurs over time due to repetitive overhead activity, trauma, previous injury, poor posture or inactivity. When your rotator cuff is weak and 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.
Shoulder impingement syndrome is common in both young athletes and middle-aged people. Young athletes who use their arms overhead for swimming, baseball, and tennis are particularly vulnerable. Those who do repetitive lifting or overhead activities using the arm, such as construction or painting are also susceptible. Impingement can also be caused by poor posture such as hunched shoulders.
Signs & Symptoms
With impingement syndrome, pain is persistent and affects everyday activities. The typical symptoms of impingement include difficulty reaching up behind the back, pain with overhead use of the arm and weakness of shoulder muscles. Rotator cuff pain can also cause local swelling and tenderness in the front of the shoulder.
Some more commonly seen symptoms of impingement are the following:
- 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.
Treatment
1. Rest - Avoid any repetitive reaching or overhead activities. Listen to your body, if something hurts - don't do it!
2. Anti-inflammatory meds - Ask your family doctor or pharmacist if it is safe for you to take anti-inflammatory medications such as ibuprofin.
3. Ice - If your shoulder is swollen and warm to touch, ice the area for 10-15 minutes at a time. Make sure you put a cloth between the ice and your skin and wait another hour before icing again.
3. Exercises and stretches:
Posture is very important! You should constantly be thinking about your posture and avoiding letting your shoulders fall forward. Try doing shoulder rolls and scapular retractions throughout the day to promote good posture.
If you are unable to lift your arm all the way up, you should start with range of motion exercises and stretches. These include pendular exercises, wall walks, and chest stretch.
Once you are able to lift your arm all the way up with minimal pain, you should begin strengthening exercises. If you don't have any small weights at home, try using a can of soup instead! Try to keep your thumbs pointing up during shoulder flexion and abduction exercises.
4. If physiotherapy does not help, you may be recommended to have a cortisone injection to reduce the pain or shoulder surgery to create more room in the shoulder joint. Surgery would be the last resort!