Shoulder pain is one of the most common musculoskeletal complaints. Of all shoulder problems, impingement syndrome is one of the most common causes, accounting for 44-65% of all shoulder conditions. In order to understand what impingement is, and how to address it, we first must understand the basic anatomy of the shoulder joint.
Anatomy of the Shoulder
The shoulder consists of 3 bones: the arm (humerus), shoulder blade (scapula), and collarbone (clavicle). The collarbone and the top of your shoulder blade and arm bones creates a gap, called the subacromial space. Tendons of the rotator cuff and biceps, along with a fluid filled sac called a bursa, all live in the subacromial space. When you move your shoulder, a natural movement pattern called scapulohumeral rhythm creates a coordinated movement of the shoulder blade and arm to allow for maximum mobility overhead.
What is Impingement Syndrome
Impingement syndrome is a condition in which the subacromial space narrows with the arm overhead, so the space available for the tendons and bursa within gets smaller. This can cause the structures to get pinched, irritated, inflamed, and even develop small microtears over time. Repetitive overhead activities that continue to irritate and damage these structures, could lead to other conditions, including bursitis and tendonitis of the rotator cuff and bicep tendons.
Risk Factors
- Impingement syndrome is commonly the result of a gradual onset due to overuse, rather than an acute injury due to trauma.
- Repetitive overhead activity, such as painting, swimming, and throwing a baseball
- Poor strength in the rotator cuff and scapular muscles, resulting in poor scapular stability and abnormal scapulohumeral rhythm
- Poor posture, especially rounded shoulders or elevated shoulders (upper trap dominance)
- In a small percentage of cases, classified as primary impingement, the cause is a structural abnormality, like a bone spur or abnormally shaped acromion at the end of the collarbone.
Signs & Symptoms
- Pain in the front and/or side of the shoulder, which can radiate down the side of the arm
- Complaints of a “pinch” in the shoulder, especially when lifting the arm overhead
- Pain can be aggravated by sleeping on the injured side, and activities that require the arm to be above shoulder height, like reaching into a cabinet, doing hair, or playing sports.
- Possible loss of range of motion due to pain, especially reaching overhead
- Possible changes in strength, due to irritation of the tendons in the subacromial space
Treatment
Impingement syndrome typically responds well to conservative treatment, including activity modification, NSAID use, and physical therapy. Physical therapy can provide treatment including:
- Thorough assessment to identify the underlying cause and risk factors to prevent re-injury
- Manual therapy to improve shoulder joint mobility, including
– Soft-tissue mobilization
– Joint mobilization
– Passive range of motion and stretching
- Individualized therapeutic exercises to address impairments, including
– Range of motion exercises
– Rotator cuff strengthening exercises
– Scapular stabilization exercises to strengthen the upper, middle, and lower fibers of the trapezius, and the serratus anterior
– Posture training
In the pictures below, we have provided a few basic exercises to begin addressing rotator cuff and scapular muscle strength (perform 2-3 sets of 8-12 reps). This list is not comprehensive, and is not one-size-fits-all. If you believe your shoulder pain might be due to impingement syndrome, working with a physical therapist to receive a thorough evaluation and an individualized, comprehensive, and progressive treatment plan is the best chance of achieving successful resolution.
External Rotation: keeping your shoulders down and back, with elbows by your side, slowly rotate your hands outwards pulling the band apart.
Mid-Trap Row: keeping your shoulders down, squeeze your shoulder blades together to bring your elbows to the side of your ribs. Do not arch your back.
Low-Trap Row: keeping your shoulders down, squeeze your shoulder blades down and back to bring your elbows to the side of your ribs. Do not arch your back.
Prone I-T-Y: lay with your chest and stomach over a ball or low ottoman, knees on or off the ground. To make an “I” squeeze your shoulder blades together to move your arms to the side of the body, keeping palms facing your body. To make a “T” squeeze your shoulder blades together to lift arms out to the side, keeping palms facing the ground. To make a “Y” position arms in front of you at 45 degrees, and pull shoulder blades down and together to lift arms up, keeping thumbs pointed towards the ceiling. Do not lift your chest up for any.
If you have any questions about this post or would like to speak with a physical therapist about an injury, give us a call at (978) 263-0007. We would be happy to answer any questions and discuss possible next steps.
Achieve Physical Therapy is currently open in Acton, Bedford, and Sudbury MA. We can see you in the office or by video treatment. If you choose to come into the office, we are following all CDC guidelines including the use of face coverings, cleaning, personal hygiene, and staggering patient appointments to limit how many people are in the office.
