Shoulder Impingement Syndrome
As the name suggests, the condition in which the shoulder rotator cuff muscles are entrapped or impinged during shoulder movement is known as shoulder impingement syndrome.
This condition produces repetitive injury to the shoulder tendons and bursa with shoulder movement resulting in Painful shoulder syndrome/ Painful Arc Syndrome. This is basically a painful range of the shoulder owing to different pathologies of shoulder tendons. This painful range varies between 60- 120 degrees of shoulder movement.
This condition can vary from mild tendonitis, bursitis, calcific tendonitis (bone forming within the tendon) through to partial and full-thickness rotator cuff tendon tears.
This condition more likely occurs in sports that require repeated overhead shoulder movements such as swimming, weight lifting, and or throwing action. Occupations that require repeated overhead activity are also at risk of rotator cuff impingement.
What are the Causes of Shoulder Impingement Syndrome:
Shoulder impingement has primary (structural) and secondary (posture & movement related) causes.
- Structural Narrowing
At times due to malformed acromion process or varying angle of inclination of acromion and or clavicle since birth reduces the space underneath the subacromial arch. This when coupled with conditions like osteoarthritis can reduce the sub-acromial space considerably causing bursitis or shoulder tendonitis.
- Secondary Rotator Cuff Impingement – Dynamic Instability
Impingement commonly occurs as a result of excessive joint movement, ligament laxity, and muscular weakness around the shoulder joint. The impingement occurs over time due to repetitive overhead activity in a poor posture. In these patients, the rotator cuff has to work harder causing fatigue, and eventually becomes inflamed and weakens due to painful inhibition or tendon tears.
In an abnormally functioning rotator cuff due to fatigue, the humeral head overrides into the sub-acromial space causing impingement of tendons and bursae present in it.
Poor technique or bad training habits such as training too hard is also a common cause of overuse injuries, such as bursitis or tendonitis.
What are the Symptoms of Shoulder Impingement Syndrome
The patient may complain of the following symptoms:
- Pain while lying on the affected shoulder.
- A painful arc ranging from 60-120 degrees of shoulder movement
- Pain localized to shoulder joint line or may travel to the elbow.
- Muscle weakness or pain when attempting to reach out or lift.
- Pain while putting the hand behind the back or head.
Shoulder impingement syndrome can be easily diagnosed by an experienced physiotherapist in a clinical setup.
An ultrasound scan may be useful to visualize dynamic impingement and detect any associated injuries.
An MRI can be used if a case doesn’t show significant improvement over time with treatment.
Treatment of Shoulder Impingement Syndrome
All the structures under the coracoacromial arch are susceptible to injury in a rotator cuff impingement case. It is of utmost importance to diagnose the exact form of rotator cuff injury as treatment varies depending on the specific or combination of rotator cuff injuries.
The ultimate aim of treatment should be to centralize the shoulder ball into its socket, which is the actual function of rotator cuff muscles. This will allow proper slides and glides of the shoulder ball in its socket while dynamically moving the arm over a stable shoulder blade. So it is also very important to ensure a dynamically stable shoulder blade.
In resistant cases or cases not responding well with conservative physiotherapy treatment can undergo corticosteroid injections to reduce the pain and inflammation. It is important to undergo physiotherapy even after corticosteroid injections to gain back the strength, power agility, and proprioception and restore the proper scapular position.
(Discuss with your Orthopaedician whether you can undergo a corticosteroid injection as it has its own side effects.)
The treatment progresses through the following stages to achieve the desired result.
- Early Injury Protection
- Regain Full Range of Motion
- Restore Scapular Control
- Restore Rotator Cuff Strength
- Restore Strength, Power, and proprioception
- Return to Sport/ Work
Get in touch with our expert at PAIN-FREE PHYSIOTHERAPY CLINIC to understand your shoulder problem better.
Every impingement case is different. Some cases show significant improvement in few sittings while a more complicated one may take few weeks or a few months to settle.
Cases not responding to conservative treatment may require corticosteroid injection or shoulder surgery.