Shoulder Impingement -There's going to be trouble!
Just a fun fact: Did you know that only 1% of our daily movements contain a range of movement where we lift our arms above our shoulders. This is one of the major issues that drives shoulder pain and injury, when we don’t lift our arms above shoulder height we are only using about 55% of our range of movement and muscles in the shoulder, as they say, if you don’t use it you lose it! So get those arms up!
Shoulder impingement is a common cause of shoulder pain. It’s also known as impingement syndrome or swimmer’s shoulder. To call it swimmer’s shoulder is a bit misleading, shoulder impingement can affect anybody but is more likely in people who carry out activities where there is a repetitive shoulder movement. So it could be any sport: tennis, squash, bowlers in cricket etc. or in fact any activity in daily life that involves repetitive movement or a posture where the shoulder muscles are activated but not moving i.e. sitting for long periods at a computer. Get the picture yet?
So let’s have a quick look at what the shoulder joint actually is: Basically it is the top of the long bone in the upper arm, the Humerus, which sits in the socket located on the top outer corner of the shoulder blade, the Scapula. Pretty simple really. It’s a bit more complicated than that, but that will do for now.
The Rotator Cuff, mmm! Interesting, I get lots of patients who have been told that they have a Rotator Cuff injury by GP’s etc. Common belief is held that the Rotator Cuff is a “thing”. Actually it’s not.
Your rotator cuff is a group of muscles and tendons that attach your Humerus into the shoulder socket and they help you lift and rotate your arm. Each one of these muscles is part of the rotator cuff and plays an important role:
Supraspinatus. This holds your Humerus in place and keeps your upper arm stable and helps lift your arm.
Infraspinatus. This is the main muscle that lets you rotate and extend your shoulder.
Teres Minor. This is the smallest rotator cuff muscle. Its main job is to assist with rotation of the arm away from the body.
Subscapularis. This holds your upper arm bone to your shoulder blade and helps you rotate your arm, hold it straight out and lower it.
If you have shoulder impingement one of the structures in your rotator cuff catches or rubs and when you lift your arm the gaps and spaces between the structures narrows, which increases pressure. The increased pressure irritates the rotator cuff, leading to impingement.
What are the symptoms?
The main symptom of shoulder impingement is sudden pain in your shoulder when you lift your arm overhead or backward. Other symptoms can include:
Minor but constant pain in your arm, Pain that goes from the front of your shoulder to the side of your arm, Pain that gets worse at night, Shoulder or arm weakness.
The above are just some of the more common symptoms that are experienced but if you feel any pain or loss of movement in the shoulder you should seek a shoulder assessment and possible treatment. Shoulder injuries can be one of those niggling things that never go away and if not treated correctly in a timely fashion can degenerate into a frozen shoulder.
What causes it?
Many cases of shoulder impingement are caused by overuse and lots of repetitive actions / movements. These don’t have to be sport based but could be the result of heavy gardening after not having done much for a while.
Using your shoulders for overhead or forceful motion is the biggest risk factor for developing shoulder impingement but it could also be as a result of poor posture.
There are certain actions and movements that are likely to put the shoulder more at risk, but you have to remember that the joint is incredibly complex with a huge range of motion and can be at risk from just about anything.
If you want to check the range of motion, just try making circles with your hand with the arm extended and see how many different angles and planes you can do it on.
How is it diagnosed?
Firstly there’s some questions about pain intensity, pain areas, range of movement and other pertinent data. Then there are a range of movement and strength tests to determine the root cause and finally some movement tests to ascertain the level of restriction.
In some cases it may be pertinent to refer for an X ray or MRI to rule out arthritis or to check out the bone structures.
How is it treated?
There are many types of treatment available for shoulder impingement, depending on how severe your case is.
Shoulder impingement usually responds well to physical therapy, which uses a range of modalities to exercise, rebuild, strengthen and restore the range of motion.
Your physical therapy sessions will likely focus on the muscles in your shoulder, arm, and chest, which can help to improve the function of the rotator cuff structures but not only the rotator cuff. For the full range of motion twenty muscles are affected and a high percentage of these may well need attending to.
The correct exercises will play an important role in recovery, helping to restore movement and strengthen the affected muscles. It’s important to follow your practitioners advice as this will change as the muscles respond and come back on line.
One of the biggest things is to have patience, the body will only recover at a rate that is correct for you. Full recuperation is highly likely, but only with the correct treatment, the relevant exercises and having the patience to give your body time to respond and strengthen.
This should always be the last option, surgery on soft tissue structures is always a risk and so much can be gained before resorting to this drastic path.
If other treatments don’t seem to work you may need surgery to widen the space around your rotator cuff. This allows the soft tissue to move freely without catching or rubbing on your bone, this can usually be done with minimally invasive arthroscopic surgery, although more severe cases may need traditional open surgery.
A recent study has questioned the benefit of removing the bone just for impingement and that is why it should always be the last resort.
Shoulder impingement usually takes about three to six months to heal completely. More severe cases can take up to a year to heal. However, you can usually start returning to your normal activities within two to four weeks but just make sure you’re following the correct advice and regularly check in with your physical therapist to make sure you aren’t overdoing it.
Being impatient can lengthen recovery time and severely increase the opportunity for re-injury.