Shoulder pain is one of the most common physical complaints, and for good reason. The shoulder has the greatest range of motion of any joint, and the sheer number of structures in the shoulder leaves room for malfunctions. Shoulder impingement is one of the most common causes of pain in the shoulder, but it’s easy to treat if caught early. In this article, we’ll dive into the shoulder impingement causes, symptoms, and treatment options.
Shoulder impingement is one of the most common causes of shoulder pain.
What is Shoulder Impingement?
Two bones in the shoulder joint sit very close to each other: the acromion (the tip of your scapula) and the humerus (the end of your upper arm bone). These bones form a protective arch, or space, around the rotator cuff tendons. Shoulder impingement happens when the bones in the shoulder pinch—or “impinge”—the rotator cuff tendon, causing pain and inflammation.
Types of Shoulder Impingement
It’s important to pinpoint your shoulder pain to make it easier to diagnose. Shoulder impingement syndrome manifests in different forms:
Internal shoulder impingement is generally found in the back of the shoulder and can be caused by excessive external rotation, like throwing a baseball.
Primary shoulder impingement is a structural issue in the shoulder, causing friction and inflammation.
Secondary shoulder impingement is often caused by lifestyle factors, such as hunching, weak back muscles, rotator cuff weakness, or poor exercise technique.
Anterior shoulder impingement happens when the head of your arm bone (humerus) is pulled anteriorly (to the front of your body) by overdeveloped pectoral, anterior deltoid, and bicep muscles.
Causes of Shoulder Impingement
Shoulder impingement is rarely triggered by one specific event. Rather, it is caused by a series of events like repetitive movements or lifestyle factors like slouching. Some people’s shoulder structure predispose them to shoulder impingement syndrome.
Those involved in activities like baseball, swimming, tennis, or golfing are more prone to developing shoulder impingement pain. You may also be susceptible if you regularly perform repetitive overhead movements like lifting, painting, or construction.
Shoulder impingement syndrome can also be caused by structural abnormalities. Structural abnormalities can create a smaller space for the rotator cuff tendon to rest, which puts extra pressure on the tendon.
Shoulder Impingement Symptoms
The symptoms of an impinged shoulder are fairly easy to recognize. If any of the following sound familiar, consult your doctor to determine whether an impinged shoulder is the cause.
Restriction and/or pain when your arm is at shoulder level or overhead
Pain when reaching behind your back or head
Weakness of shoulder muscles
Pain or weakness when lifting objects
Pain when lying on the affected shoulder
Persistent shoulder pain
Shoulder Impingement Diagnosis
Giving your doctor specific examples of your symptoms helps them properly diagnose your pain. Here are a few methods your doctor will use to render a diagnosis.
Your doctor will ask you about symptoms, job duties, and hobbies and will assess your muscle strength and posture.
Simple shoulder impingement tests involve moving the shoulder into different positions. The most common tests are the Neer Test and the Hawkins Test. If you have shoulder impingement, you’ll most likely experience pain when these tests are done properly.
If the physical tests do not deliver definitive results, your doctor may order an X-ray or MRI. X-rays don’t always reveal the extent of shoulder impingement, so MRIs are used more often. They do not use any radiation and give clear pictures of shoulder abnormalities.
Shoulder Impingement Exercises & Treatment
Here are a few options for treating your shoulder impingement. Talk to your doctor to determine the treatment plan that’s best for you.
Shoulder Impingement Physical Therapy
Physical therapy is the most common, safest, and most effective form of treatment. Shoulder impingement physical therapy exercises may be used in conjunction with anti-inflammatory medication,contrast therapy, and posture improvement education. Rehabilitation typically involves:
The physical therapist will manipulate your arm and shoulder.
These exercises and shoulder impingement stretches improve flexibility and help the shoulder move properly.
Your physical therapist will decide which strengthening exercises are right for your condition, based on severity and your abilities.
You will learn correct posture and body mechanics to employ during your job, hobbies, and fitness routine.
Apply an ice pack to your shoulder to relieve pain and reduce swelling. This may be done during the first few days following injury and after physical activity.
A shoulder brace is crucial for stabilizing and protecting your fragile shoulder to prevent further damage. ( See Product)
A shoulder brace is crucial to a full shoulder impingement recovery. A brace stabilizes and supports your injured shoulder to prevent further damage. Look for a brace made of breathable material for comfortable all-day wear, and make sure it's adjustable so you can properly fit the support to your shoulder. Talk to your doctor to determine how long you will need to wear your brace.
Shoulder Impingement Surgery
If non-invasive methods fail to provide relief, severe cases of shoulder impingement syndrome may require surgery. This surgery, called subacromial decompression, involves shaving bones to open the subacromial space, allowing more room for the rotator cuff tendon to rest comfortably and is only employed in the case of structural abnormalities. Recovery time is typically a few months.
Surgery may also be necessary in the case of a torn rotator cuff tendon. This involves a more extensive surgery, with a longer recovery.
Cortisone Injection for Shoulder Impingement
Cortisone injections of the shoulder decrease inflammation significantly. When injected into the surrounding tissues, the cortisone steroid is absorbed and reduces irritation for a long period of time, sometimes months.
Cortisone should be used with care, as it has the potential to weaken tendons, and muscles, ligaments.
Shoulder Impingement Recovery
Shoulder impingement recovery time varies depending on severity and the individual. An experienced physical therapist can address shoulder impingement recovery in stages, which takes two to six months—or longer for athletes. Of course, urgical procedures requires longer recovery time.
Prevention is always the best route, especially if your genetics or activities predispose you to shoulder impingement syndrome. Olympic weightlifters, a tennis players, swimmers, or other athletes should perform shoulder impingement exercises before and/or after exercise to prevent injury. Remember to maintain good posture—sit up straight and use proper body mechanics during sports and daily activities. Treat your shoulders well and they will reward you with years of pain-free use.
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