What is Shoulder Impingement Syndrome?
A large percentage of the patients we see in physical therapy here at the UVM Medical Center have shoulder impingement syndrome – one of the most common causes of shoulder pain in adults. It occurs when the acromion places pressure on the rotator cuff tendons as the arm is raised, causing pain and limited movement.
The acromion is a bony shelf formed by part of the shoulder blade (scapula) that sits over the “ball” of the shoulder joint (the humeral head).
The rotator cuff is a group of four muscles, whose tendons all attach around the humeral head. The rotator cuff helps to lift and rotate the arm, and stabilizes the ball of the shoulder within the joint.
Shoulder impingement is a progressive condition. The impingement starts out as mild, acute inflammation, but as it progresses, degeneration and tearing of the rotator cuff tendons eventually results, particularly if left untreated.
Shoulder Impingement Syndrome Risk Factors
Shoulder impingement is most common in young athletes and middle-aged individuals. Athletes who regularly use repetitive shoulder motions, like baseball pitchers, tennis players, and swimmers, are at higher risk of developing impingement. Workers whose jobs involve repetitive lifting or overhead activities, like painters, carpenters, or electricians, are also more likely to develop shoulder impingement.
There are also intrinsic factors that place individuals at greater risk for shoulder impingement. The shape of the acromion, or the degenerative changes that occur in some individuals with aging can be contributing factors. Poor posture and weak or imbalanced shoulder muscles can also contribute to impingement.
Symptoms of Shoulder Impingement Syndrome
Symptoms of shoulder impingement syndrome can range from mild to severe, and the onset is usually gradual. Symptoms of shoulder impingement syndrome include:
- Pain in the front of the shoulder, which often radiates to the side of the upper arm.
- Increased pain with lifting, reaching, and overhead activity (such as throwing or serving a tennis ball). Pain may also occur when the arm is lowered from an elevated position.
- Local swelling and tenderness over the front of the shoulder can also occur.
- As the impingement progresses, pain may be present at night, and loss of strength and/or range of motion may occur. Difficulty reaching behind the back, reaching out in front, or with overhead activity is also typical.
Shoulder Impingement Syndrome Diagnosis
Shoulder impingement can usually be diagnosed right in the office, with a thorough history and clinical examination. A doctor may request further imaging studies, such as X-rays to look for bone spurs on the acromion, or an MRI (magnetic resonance imaging), to look for rotator cuff degeneration or tearing.
Shoulder Impingement Syndrome Treatment
Initial treatment for shoulder impingement syndrome is always non-surgical. Rest and avoidance of overhead activities are very helpful in the acute stages. A physician might also recommend a course of oral anti-inflammatory medications, corticosteroid injection, or physical therapy. More severe cases of impingement syndrome that have failed to respond to conservative treatment are referred to an orthopedic physician to consider the need for surgical intervention.
Physical therapy is very helpful in treatment of shoulder impingement syndrome, particularly in the early stages. Research shows that individuals who receive active physical therapy experience greater improvement in function and decreased pain intensity, compared to those performing an exercise program alone.
What do physical therapists offer for shoulder impingement treatment?
- Control acute symptoms through rest, activity modification, and sometimes anti-inflammatory treatments like ice or electrical stimulation (TENS).
- Correct posture to open up the space under the acromion, and relieve pressure on the rotator cuff tendons.
- Stretch what’s tight, typically the posterior capsule, or back portion of the shoulder joint, in the case of impingement syndrome.
- Strengthen what’s weak. The rotator cuff and periscapular muscles usually need work. Not only do they need strengthening, but they also require re-education to help them work together, and contract at the right time during shoulder movements.
- Focus on proper biomechanics. This means working on lifting technique, or correcting mechanics during pushing, pulling, and overhead activity to avoid stress on the rotator cuff tendons. In athletes, close attention is paid to mechanics during throwing, tennis serve, or swimming.
- Rest your shoulder. Avoid movements that trigger the pain. Limit overhead activity or repetitive reaching/lifting with the affected arm until the shoulder pain subsides.
- Use ice. Applying cold packs or ice to the shoulder can help reduce inflammation and pain. Wrap either a cold pack, bag of ice, or package of frozen vegetables in a towel or pillowcase. Apply to the painful area for 15-20 minutes at a time, up to once every 1-2 hours as needed.
- Consider over the counter anti-inflammatory medications. Talk to your doctor about whether over-the-counter non-steroidal anti-inflammatory medications (NSAIDs), such as aspirin, ibuprofen, acetaminophen, or naproxen might be appropriate for you to reduce inflammation and help speed along the healing process.
- Work on restoring motion. Try gentle range of motion (stretching) exercises to keep your shoulder moving as it should. Inactivity can lead to stiff joints and loss of motion. Work within a pain-free range until normal shoulder motion is regained. Once full pain-free range of motion has returned, it is safe to try gradually returning to previous exercises or recreational activities.
- Consult with a healthcare professional if you are experiencing severe shoulder pain, you are unable to use your arm or feel weak in the arm, or if you have shoulder pain that’s lasted for more than a week.
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Jill McDougall, PT, DPT is a physical therapist and a Manager in Rehabilitation Therapies at the UVM Medical Center’s Orthopedic Specialty Center on Tilley Drive in South Burlington, Aquatic Physical Therapy in Winooski, and at South Burlington Family Practice Physical Therapy. Her areas of practice expertise include outpatient orthopedics, sports medicine, lower extremity biomechanics, and rehabilitation of the injured worker.