Shoulder impingement is a very common cause of generalized shoulder pain.
The shoulder is the most mobile joint in the body which in turn makes it the least inherently stable joint as well. The shoulder joint is made up of 3 bones: the Humerus (arm bone), the scapula (shoulder blade), and the clavicle (collar bone). The joint itself is a shallow ball and socket joint with many muscular and cartilaginous structures to support it. Throughout the joint there are multiple bursa sacs which act as friction reducers between bony and soft tissue structures of the joint.
Shoulder impingement syndrome is when the bursa that lies below the subacromial arc is inflamed and causes pain in the superior/lateral arm. Impingement can be caused by a traumatic event but is more commonly an overuse injury caused by activities such as weight lifting, performing repetitive overhead work, swimming, or throwing. Also, structural abnormalities such as a narrowing of the subacromial space, hypertrophy of the Supraspinatus tendon, and forward/rounded shoulder posturing can also lead to shoulder impingement syndrome.
Signs and symptoms of shoulder impingement include but are not limited to pain with reaching behind back, pain with reaching over head, a painful arc of motion, pain along the lateral arm and at the acromial arch. This pain can be sharp with certain movements but is often times dull without activity and can limit all activities of daily living. Weakness is often noted with rotation of the shoulder especially the external rotators. It can be diagnosed through a series of special tests performed by the physical therapist often times without the use of x-ray or MRI.
Shoulder impingement can often be resolved non-surgically through physical therapy interventions:
- Manual Interventions: A skilled PT or PTA can perform hands on treatment which include soft tissue release to inflamed muscles, joint mobilizations to improve joint capsule mobility, manual resistive exercises for joint stabilization and physical reassessment of joint mechanics and function.
- Therapeutic Exercises: The physical therapy team work together and with you to develop an individualized exercise program geared specifically to you and your shoulder. These exercises help to activate and strengthen the proper muscles for your specific needs.
- Stretching: Stretching performed to improve joint and soft tissue mobility and allow for proper postural alignment of the joint.
- Postural Training: Exercises and activities geared toward gaining and maintaining proper postural alignment of the shoulder is crucial for maintaining progress throughout treatment.
- Job/Sport Specific Exercise: The physical therapy team will work together to integrate any specific job or sport related activities into your exercise program. This integration allows for a quicker and more effective return to work/sport.
- Home Exercise Program: Probably the most vital part of any physical therapy episode. The physical therapist will develop and provide written instructions on which exercises are most vital to be performing at home in between physical therapy treatments. Performance of home exercise programs greatly improve speed and effectiveness of all physical therapy interventions.
- Modalities: The physical therapy team will integrate a number of modalities to decrease the inflammation of the shoulder joint: interferential electrical stimulation, vasopneumatic icing, cold pack, ultrasound, phonophoresis, and iontophoresis among others.22555
“Studies show that conservative management of shoulder impingement syndrome resolves the problem in 70-90% of patients. In symptomatic patients a course of conservative management is widely accepted as first line management but the time frame for this is variable and a point of controversy. Most surgeons generally tend to observe patients for a 6 month period however based on individual patient factors this can vary. For patients older than 50, a longer period of conservative treatment may be warranted but when managing these cases in the athletic or young individuals (<40 years) with acute trauma and injury to the rotator cuff, surgical intervention should be considered at an earlier time as successful repair allows these particular patients to return to pre-injury level of function.” (Khan et al.)
If you feel you are experiencing symptoms of shoulder impingement you may want to contact your physical therapist. Under what is known as Direct Access, you can now see a physical therapist for the equivalent of 6 visits or 30 calendar days without a physician’s referral. The physical therapist is trained in diagnosing musculoskeletal injuries and will be able to refer you to a physician if further consultation is needed.
Khan Y, Nagy MT, Malal J, Waseem M. The painful shoulder: shoulder impingement syndrome. Open Orthop J. 2013;7:347–351.