What is Shoulder Impingement?
Shoulder impingement also called swimmer’s shoulder, is where certain structures of the shoulder press upon each other causing inflammation, irritation, and pain. The shoulder joint is a dual-jointed and multi-directional joint.
Whenever there is a multi-directional and complex joint like the shoulder, the risk of injury goes up. To understand shoulder impingement and how it occurs, a basic understanding of the shoulder anatomy is needed.
The three main bones of the shoulder are the humerus, scapula, and clavicular bone. The upper arm bone, called the humerus, is shaped like a ball which fits the scapula, also known as the shoulder blade. This ball and socket joint’s main purpose is to connect the upper arm to the main body also known as the trunk or thorax.
The clavicle bone, also known as the collarbone, meets up with a bony projection of the shoulder blade, called the acromion. Where the collarbone and shoulder blade meet, this joint is known as the acromioclavicular joint. This joint allows for you to lift your arm overhead and to rotate your arm.
The complexity of the shoulder joint extends beyond the bones that comprise of the shoulder. There are three other main structures to the shoulder. The most commonly known structure of the shoulder is the rotator cuff which is made up of muscles and tendons. The purpose of the rotator cuff is to stabilize the joint and to allow for movement, particularly rotation.
Collectively, the ball and socket joint of the shoulder along with the rotator cuff muscles and tendons allow for the shoulder to have significant multi-directional movements. So, to help protect the rotator cuff, the shoulder has a bursa sac filled with fluid protecting and cushioning the tendons of the rotator cuff.
The final main structure of the shoulder is the labrum which is cartilage shaped like a cuff that the humerus fits inside. The labrum and humerus are relatively loose fitting to allow for movement in the shoulder, but it does its job to help hold the shoulder joint together, also known as stability.
What causes shoulder impingement?
Impingement of the shoulder occurs when the acromion presses against the rotator cuff as the arm lifts. The natural space for the bone structure and tissue to move freely becomes, in a way, compressed. With repeated pressure and movement, the rotator cuff becomes irritated and inflamed and is called shoulder impingement, also known as rotator cuff tendinitis.
Typically shoulder impingement occurs with repeated overhead movement of the shoulder, and in some cases, basic genetic structures of one’s shoulder can make a person more susceptible. Also, weak shoulder muscles can play a part in shoulder impingement.
One of the primary jobs of the muscles and tendons in the shoulder is not just for movement, but also to stabilize and help proper movement throughout the joint range of motion. When any muscle, or group of muscles, become weak this causes unnecessary and problematic movement within and around the joint.
Without proper treatment of the shoulder when it is in this inflamed stated, it can lead to a rotator cuff tear because over time with prolonged irritation the rotator cuff breaks down and then tears.
Symptoms of Shoulder Impingement
Quite commonly, pain occurs towards the front, or anterior, of the shoulder. Symptoms may also radiate into other areas such as the neck or down the side of the arm. Movements such as reaching overhead or behind one’s back becomes painful and in some cases, difficult. Sleeping on the affected shoulder may also cause disturbed sleep due to increasing shoulder pain.
Decreased range of motion of the shoulder along with increased pain may gradually worsen over time, especially if movement patterns don’t change or a patient did not receive proper treatment. As symptoms progress, there is a higher likelihood of symptoms progressing including pain occurring at rest, worsening at night, or even loss of muscle mass and strength in the shoulder and arm.
How is shoulder impingement diagnosed?
Commonly, with proper diagnosis and treatment, this is a treatable condition without surgical intervention. Diagnosis can occur without imaging like an X-ray or MRI. A physical therapist, trained in differential diagnosis, can complete a full evaluation of the shoulder to determine if impingement is the culprit causing the symptoms.
An evaluation by a physical therapist includes testing muscles and range of motion of the shoulder, arm, and neck. They will look to determine the impact on any structures and any muscles or tendons that may be weak or imbalanced.
In addition to the physical exam, a physical therapist will look to understand specific job duties, hobbies, and will assess posture to see if there are triggering factors or activities that match-up with the physical exam and causes of shoulder impingement.
In some cases, an X-ray or MRI may be needed to diagnosis the shoulder. If this is the case, a physician will complete a full history and exam to determine the best diagnosis and treatment approach.
Treatment of Shoulder Impingement
There are various treatments for shoulder impingement. From most conservative to more aggressive treatment, this is a treatable condition. The most conservative approach to shoulder impingement is to receive physical therapy services.
There are various treatment styles physical therapists may use to maximize their client’s outcomes. In general terms, the physical therapist will follow standard protocols for shoulder impingement injuries which include manual therapy, exercise, posture retraining, and in some case address ergonomic needs.
The main goal of therapy is to reduce pain and any swelling to the area along with properly strengthen the shoulder and upper back muscles that will assist in alleviating the impingement, retrain muscles to improve proper movement patterns, provide instruction on appropriate exercises, and assist with returning to function.
Physical therapy is not a cookie cutter approach which is why each client needs an evaluation and a customized treatment created. The best way to find a highly qualified physical therapist near you, is to visit FOTO’s website at (do we want to insert FOTO database here?). Here you will find highly qualified therapists in your area. How do we know this? It is because they all track their outcomes to the care they provide. They are focused on quality care and outcomes.
In some cases, where the shoulder is so inflamed, a physician may prescribe a non-steroidal anti-inflammatory medication. The anti-inflammatory may be a prescription dose of ibuprofen or naproxen. In both cases, the goal is to reduce inflammation and in turn then reducing shoulder pain. A non-steroidal anti-inflammatory may help to manage symptoms, but it is not a cure to the problem. The recommendation is still, physical therapy.
In severe cases, a patient may require a shoulder injection. If anti-inflammatories and physical therapy do not help in increasing function and reducing symptoms, a physician may treat the shoulder with a steroid injection into the shoulder. Commonly cortisone is injected into the shoulder as it has been proven to reduce pain which will then allow a physical therapist to work on strengthening the shoulder with reduced symptoms.
In the most severe cases, a patient may require surgical intervention. When all other avenues to control symptoms and improve function have failed, then a surgeon will repair the shoulder through a procedure called subacromial decompression. In this procedure, quite common the surgeon removes part of the acromion bone and possible some bursal tissue.
Recovery of the surgery will depend on multiple factors including severity of the impingement, how much structure and tissue was cleaned up and removed, and if there were any other complications. Often it can take on average 2 to 4 months before pain relief and in some cases up to a full year before full recovery occurs.
During the recovery period after surgery, the recommendation is physical therapy. Physical therapists can help manage pain, improve range of motion, and return to activities such as work and hobbies safely.
If you are experiencing shoulder pain that impacts your daily activities such as work and hobbies, medical intervention is recommended. As a consumer of health care, you have a choice in finding the right provider for you. Do your homework and search for a health care provider, like a physical therapist, with excellent outcomes, great customer reviews, and can provide you the care you need for a reasonable cost.
Most states have direct access to a physical therapist, meaning you can go directly to a physical therapist without a physician order. To determine if your state has direct access, please visit the American Physical Therapy Association’s website Physical Therapy Direct Access By State.
If you are uncertain with how direct access works in your state, a good starting point would then be to visit with your primary physician. He or she can establish a plan with you to ensure you are getting the health care you need.
To find a highly qualified PT near you, please click on Find A Clinic. Here you will find highly qualified PTs. There are many PTs to choose from, but we can help you find a local PT that has top national outcome rankings for shoulder care.