Shoulder Impingement Syndrome
By: Tourage Rafeei, PhD, DPT, OCS, Cert. DN
Impingement syndrome is sometimes called swimmer’s shoulder or thrower’s shoulder. It is caused, primarily, by inflammation of soft-tissue structures as they pass through the shoulder joint space (Subacromion Space).
Shoulder complex is made up of three bones:
upper arm bone (Humerus),
shoulder blade (Scapula), and
Your arm is kept in the ‘socket’ (Glenoid Fossa) by rotator cuff muscles (Supraspinatus, Infraspinatus, Teres Minor, and Subscapularis) and other structures (including supporting ligaments and the Glenohumeral capsule)1
The Subacromial Bursa is a fluid-filled sac the helps prevent wear and tear of the muscles in the shoulder joint. This bursa allows the tendons to glide freely when you move your arm, especially overhead and across the front of your body.
Shoulder impingement is common in both young athletes and the middle-aged population. This dysfunction is caused by the tendon of the Supraspinatus, long head of the biceps, and/or subacromial bursa becoming impinged or compressed as they pass through the Subacromial space during activity. With the repetitive pinching the tendons, and/or the bursa, they become irritated and inflamed. This can lead to thickening of the tendon, which may further compress and irritate the shoulder joint. Those who do repetitive motions, such as lifting, overhead activities, construction work, or painting are also susceptible. If left untreated, this type of shoulder dysfunction can lead to more significant injuries, such as rotator cuff tear or scapular dyskinesis.
Shoulder Impingement Syndrome can cause pain that comes on gradually over a period of time, mainly on top of the shoulder or on the side of your upper arm. You may experience pain during routine, daily activities, as well as during sporting activities such as throwing, racquet sports and swimming
The symptoms during the early stage of impingement may be mild; however, it is important to address the certain limitations, weaknesses, or muscle dysfunctions before symptoms progress. If you begin to experience these symptoms, consider seeing your physical therapist for an assessment!
– pain that is present with daily activities
– pain may radiate to the side of the arm
-sudden pain with lifting and reaching movements
-athletes in overhead sports may have pain when throwing or swinging racquets over your head
If these symptoms progress, you may notice the following:
-pain with activities and at rest
-loss of strength and motion
-difficulty performing normal activities
Impingement syndrome can usually be diagnosed by asking specific questions and performing a comprehensive physical examination2. Your physical therapist will perform certain tests to evaluate your shoulder for reproducible pain and dysfunction. These tests will help determine what structures or issues may be causing your shoulder pain symptoms.
Impingement syndrome is usually treated conservatively. You will be guided through a specific protocol of exercises to restore the function of your shoulder. To help facilitate the effectiveness of these exercises, your physical therapist will perform manual therapy and other treatment techniques to help speed the rehab process. Depending on the severity of your symptoms, it may take 6 to 8 weeks of physical therapy for your shoulder to improve significantly. There are a lot of factors that directly affect your recovery. Those include: patient age, severity of diagnosis, time-frame since onset of pain, co-existence of other pathologies, and compliance with treatment protocol3.
Injection: If there is significant amount of inflammation, your doctor may provide a medicated injection to your shoulder. The purpose of this injection is to help reduce the acute irritation and inflammation of the shoulder joint. This helps by giving you a window to start your therapy, allowing for a more aggressive treatment approach. In rare situations, surgical procedure(s) may be performed to reduce the pain caused from impingement. These procedures may include rotator cuff repair, sub-acromial decompression, or biceps tenodesis.
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- Armstrong, A. American Academy of Orthopaedic Surgeons. Shoulder Impingement/Rotator Cuff Tendonitis. http://orthoinfo.aaos.org/topic.cfm?topic=a00032. February 2011. Accessed September 14, 2017.
- Reinold, M. Shoulder Impingement – 3 Keys to Assessment and Treatment. https://mikereinold.com/shoulder-impingement-3-keys-to/. November 15, 2010. Accessed September 14, 2017.
- Dong W, Goost H, Lin X-B, et al. Treatments for Shoulder Impingement Syndrome: A PRISMA Systematic Review and Network Meta-Analysis. Sahin. A, ed. Medicine. 2015;94(10):e510. doi:10.1097/MD.0000000000000510.