Shoulder Impingement! What is it and how do we treat it

Shoulder Impingement Syndrome

A common condition individuals can be affected by is an impingement of the shoulder or ‘pinching’ of the rotator cuff and even the biceps tendon. When this occurs, there is shoulder inflammation and swelling to the rotator cuff; it is very similar to your car having an alignment issue. When you’re car has an alignment issue, it creates abnormal stresses to the front end and can start to wear your tires more quickly to one area. Having a shoulder impingement means there is an underlying problem, but it does not tell you the cause. Poor shoulder mechanics or abnormal movement pattern where the shoulder blade is moving differently is a shoulder or scapular dyskinesia.

SHOULDER IMPINGEMENT SYNDROME IS A SYMPTOM

NOT A DIAGNOSIS

What happens to the shoulder with impingement syndrome?

The underlying cause of shoulder impingement is abnormal biomechanics, i.e. an abnormal movement pattern has developed. The arm bone, humerus, does not glide downward as much as it should due to restricted joint motion and pinches the rotator cuff between the acromial process, which happens every time you raise your arm. Ouch!

This pinching or abnormal movement pattern creates a painful arc of motion when this happens

SYMPTOMS

• Pain with lifting the arm or hand above shoulder height
• Drop arm – your arm feels like it ‘gives way’
• Pain with bringing your arm across your chest
• Pain with exercising the shoulder, i.e. lifting weights, pushups, tri-cep extensions, etc.

   

TESTS

A way to test for shoulder impingement is to raise your arm as high as you can. Is there any pain? When does the pain occur? If pain occurs in the middle of your motion, followed by less pain when your hand is high up above your head, this is a sign of a ‘painful arc’ and shoulder impingement. This is a common finding with almost every shoulder problem.

DIAGNOSTIC ULTRASOUND

Shoulder impingement can be seen with diagnostic ultrasound. While raising your arm, the diagnostic ultrasound can see the head of the humerus and assess its mobility. If the humerus does not descend then the greater tuberosity will pinch the rotator cuff between the acromial process. Essentially, the rotator cuff is being ‘ground or pinched’ between two bones when you raise your arm. This can occur without pain if the inflammation is low. That means that minor damage and micro-trauma is occurring, but the risk of a rotator cuff tear or injury is higher the longer you have pain and poor shoulder mechanics.

Diagnostic Ultrasound can also show swelling and inflammation of the rotator cuff and bursa, as well as thickening of tissue due to chronic ‘pinching’. Any damage to tendons will be clear with diagnostic ultrasound.

TREATMENT

The best treatment for a shoulder impingement is to address the poor shoulder mechanics. Back to our example, if you have an alignment problem with your car, driving faster and more aggressively won’t decrease your tread wear.

You need to ‘fix your alignment’.

FIX YOUR SHOULDER ALIGNMENT

STEROID INJECTIONS

Steroid injections, specifically to the sub-acromial space, can reduce inflammation and reduce pain significantly. Some practioners typically recommend an injection if pain is not quickly being resolved during treatment. You will know immediately if the injection worked because of the numbing medication in the injection. If you have less pain with raising your arm, then the needle was placed in the right spot. Steroids take time to have an effect, 3 to 5 days is not unusual to see if your injection worked. You may need to have a guided injection with diagnostic ultrasound to confirm proper placement of the needle and medication.

BUT a steroid injection does not treat the cause and shoulder problems can return.

TREAT THE CAUSE!

It is the underlying cause that is causing the shoulder dyskinesia or abnormal movement pattern of the shoulder.

   Wait, there's hope!   

Here are some things you can do and things you need to avoid with a shoulder impingement.

You know you have shoulder impingement syndrome when…

• Light exercises make it feel better but increased overhead exercises can increase your pain.
• Your pain gets better with rest but returns with increased activity.
• You have pain when you stretch your shoulder, bringing your arm across your throat or chest.
• You have had to change or stop some activities because of pain.
• You have chronic shoulder pain.

4 things you should do to increase your chance of success when treating a shoulder impingement problem.

JOINT

Address the underlying shoulder joint restriction. Until you address the joint motion, the mechanics will remain affected and ‘pinching’ continues. If you do not have a physical therapist treating you, then here is a self-mobilization you can try.

MUSCLE

Muscle trigger points can be present with limited mobility and tension present. Dry needling is a great way to reduce muscle trigger points and can be more effective than massage or stretching.

MOVEMENT

The first step is to restore shoulder motion to normal. This may be better with a personal trainer or physical therapist assessing your motion, but you can also see how your shoulder moves in front of a mirror. When your mechanics are better you can start increasing your activity and exercises.

REMEMBER - NO PAIN WITH EXERCISES!

PREVENTION

Lastly, we want to make sure that your problem does not return. This is the time to look deeper into your posture, and shoulder activities you do a lot of, to make sure you have good movement habits.