Shoulder impingement is the most common shoulder condition we see in our clinic.
It happens when the tendon(s) (tissue which connects muscle to bone) gets pinched between the bones of the shoulder. The shoulder is a ball and socket joint: The ball of the humerus (long upper arm bone) and the fossa (“shoulder socket”) of the shoulder blade, or in medical terms, scapula. As we elevate our arms, this space gets smaller. Normally the tendon just slides under this space as we lift our arm. With shoulder impingement, the tendons are thickened from repetitive strain, overuse, or injury. They get pinched between the bones during movement, causing pain. Other causes include bone or joint abnormalities or arthritis.
There are certain exercises that are harder on shoulder impingement. Overhead activity of the shoulder, especially repeated activity, is a risk factor for shoulder impingement syndrome. Examples include: Pickleball, baseball, painting, lifting, swimming, tennis, and other overhead sports. Other risk factors include bone and joint abnormalities.
With impingement syndrome, pain is persistent and affects everyday activities. Motions such as reaching up behind the back or reaching above shoulder height can cause pain. This can make even dressing and daily hygiene tasks painful.
If not treated appropriately, the rotator cuff tendons can become more compromised. This can lead to worsening pain and could lead to a rotator cuff tear.
Symptoms of Shoulder Impingement Syndrome
The typical symptoms of impingement syndrome include difficulty with pain with overhead or over-shoulder height use of the arm, reaching up behind the back, and overall weakness of shoulder muscles.
If tendons are injured for a prolonged period of time, the tendon can actually tear, resulting in a rotator cuff tear. This causes significant weakness and may make it difficult for the person to elevate their arm. Some people can have a rupture of their biceps muscle as part of this ongoing impingement process.
How Is Impingement Syndrome Diagnosed?
Diagnosis of impingement syndrome begins with a medical history and physical exam by your doctor or Physiotherapist. X-rays will be taken to rule out arthritis and may show changes in the bone that indicate injury of the muscle. Bone spurs or changes in the normal contour of the bone may be present.
How Is Shoulder Impingement Syndrome Treated?
Physiotherapy is the primary treatment for shoulder impingement syndrome. Oral anti-inflammatory medications, such as aspirin, naproxen, or ibuprofen, can help reduce pain and swelling and allow your Physiotherapist to be able to do more manual therapy ( joint mobilizations, muscle energy techniques, passive stretching of muscle, trigger point release of muscle, friction massage of tendon and so on) This can get you feeling better sooner but also improve your tolerance of these hands-on techniques. Of course, this needs to be cleared by your doctor as these medications may interfere with any prescriptions you are currently taking.
Stand with your arms at your sides and try to squeeze your shoulder blades together and then down. Hold the position for 5 seconds and then relax. Perform about 10 repetitions twice daily.
Scapula Push and Pull
Place your arms out horizontally in front of your body. Extend your arms forward and backward in the horizontal plane by slowly moving your shoulders only—no hold needed. Perform about 10 repetitions twice daily.
Chest / Pec Stretch
Stand in a doorway and place your forearm on the door frame. Gently turn your body away from the arm until you feel a good stretch in your pectoral muscles. Hold the position for 5 seconds and then relax. Perform about 10 repetitions twice daily. A typical chest stretch is when your elbow is at the same height as your shoulder. If you are experiencing pain with this exercise, you could try lowering your elbow a bit, and this pain should resolve.
Front / Anterior Shoulder Stretch
Stand in front of a wall, and place your hand on the wall starting at stomach level. Slowly move upward until you feel a stretch in the front shoulder region. Hold the position for 5 seconds and then relax. Go as high as you feel comfortable. Perform about 10 repetitions twice daily.
Back / Posterior Shoulder Stretch
Place one arm across your body and use your other arm to pull it tightly towards your chest until you feel a gentle stretch of the muscles at the back of the shoulder. Hold the position for 5 seconds and then relax. Perform about 10 repetitions twice daily.
External Rotation Stretch
Stand and place your hand palm down on the edge of a wall, keeping your elbow tucked at your side against your body.
Turn your body the opposite way without moving the elbow until you feel a stretch.
Hold the position for 5 seconds and then relax. Perform about 10 repetitions twice daily.
If you have been diagnosed with a shoulder condition, it is best to consult your doctor or Physiotherapist before incorporating these exercises into your regular workout routine.
Along with exercise, you need to also avoid irritating factors such as:
- Repetitive activities with your injured arm, particularly activities where the elbow would move above your shoulder height.
- Sleeping on the injured side; this can further compress and irritate the rotator cuff tendons. Although some patients do this as the pressure can be distracting and help them fall asleep, it is advised to avoid this position.
- Avoid heavy lifting.
If symptoms persist or if significant weakness is present, then your Physiotherapist may recommend you ask your doctor for an MRI to rule out a rotator cuff tear. If the rotator cuff is torn, surgery may be necessary to repair it.
The vast majority of people who have impingement syndrome are successfully treated with medication, stretching exercises, and temporary avoidance of repetitive overhead activity until the condition settles down.
As well, relaxation massage therapy in Winnipeg will always help you feel better, no matter what’s going on, so contact us at Fit4Life today.
“Take care of your body, and it will take care of you!”—F4L