A PHYSICAL THERAPIST'S GUIDE TO SHOULDER IMPINGEMENT - AMY WARR, MSPT
Shoulder impingement is a common cause of shoulder pain, which occurs when the tissue underneath the bones of the shoulder get trapped when the arm is raised overhead. This type of repetitive activity can cause pain, inflammation, and limited mobility. Typically, this condition develops over time and primarily involves the tendons of the rotator cuff. It occurs most frequently in young athletes and people of middle-age who engage in overhead activity, such as swimming and tennis or occupations that involve overhead lifting. Sometimes, there is no known cause.
To understand more clearly the cause of impingement it helps to have a picture and understanding of the anatomy. The shoulder is made up of three bones. The scapula, the humerus, and the clavicle. The acromion, which is part of the scapula, forms a roof over the shoulder which the tendons pass through. This subacromial space can be small, and as one raises the arm up, the space can become smaller, pinching the bursa and rotator cuff tendons beneath.
Impingement symptoms start off as mild with pain experienced with raising the arm up. If not addressed it can progress to pain at rest and at night, decreased mobility, and difficulty reaching behind your back. Pain can be experienced in the front of the shoulder and radiating pain down the side of the upper arm.
HOW IS IMPINGEMENT SYNDROME DIAGNOSED?
Shoulder impingement can be a waste basket term for shoulder pain. Impingement can have primary or secondary causes, which is important when determining the treatment approach. A detailed medical history should be performed to include an X-ray. This may help to rule out any anatomical variances. Structural causes that compromise the joint space may include bone spurs or a hooked acromion. Secondary causes include muscle imbalance, or joint restrictions that cause impingement with overhead reaching. Location of the pain provoked by clinical exam can assist in determining the type of impingement and direction of intervention. Issues with your cervical spine will also be ruled out to make sure that a pinched nerve is not the cause.
HOW IS IT TREATED?
Non-steroidal medication to manage inflammation, physical therapy, and activity modification is the initial course of treatment. Your therapist will also perform a detailed exam to assist in determining the area of impingement, whether sub-acromial, coracoacromial, or posterior impingement. This also helps to determine the course of your physical therapy intervention.
If these conservative interventions fail, a cortisone injection may be recommended to help with inflammation, and to improve tolerance to physical therapy intervention. If this treatment is unsuccessful in reducing persistent pain and/or weakness, then an ultrasound or MRI may be ordered by your physician to rule out rotator cuff tear. Most cases of impingement resolve with conservative treatment. However, a surgical approach that provides more space for the rotator cuff can then be performed arthroscopically if conservative management fails.
FAVORITE STRETCHES FOR IMPINGEMENT
CROSS BODY - Pinch shoulder blades together and bring your arm across your chest starting with 10 second hold, 10 repetitions.
INTERNAL ROTATION STRAP STRETCH - Grasp towel or strap and pull affected arm up your back until tension in felt. Try to let the elbow relax forward. Hold for 10 seconds and repeat 10 times.
These stretches may not be appropriate for every person who thinks they may be suffering from shoulder impingement. Stretches may have to be modified depending on your limitations. If you are suffering from shoulder pain, Aquahab Physical Therapy offers free screenings to assess your complaints and recommend the appropriate direction of care. Skilled therapy is also available with all insurances accepted.
Video demonstration by Amy Warr, MSPT below.