What is Shoulder Impingement?
Shoulder or subacromial impingement is a term that has been around for a long time but it still causes a lot of confusion in both patients and the physiotherapy world. Impingement is widely known as a lack of space underneath the acromion, (a bone that is part of the shoulder blade), which could cause pinching of shoulder tendons as you move the arm.
The space underneath the acromion is called the subacromial space. Traditionally the narrowing of the subacromial space was thought to have two possible causes:
- Bursitis (an inflammatory reaction in a fluid filled sac like structure in the shoulder) or
- The shape of the acromion.
Is this the true cause of impingement?
Research is now starting to disprove these two theories. We now know that there is no linear correlation between the size of the subacromial space and onset of shoulder pain/symptoms. Research is also showing that weakness of the rotator cuff (stabilising) muscles of the shoulder is the most likley cause of impingement pain.
This blog post aims to help you understand what is happening, why it is causing you pain and how to help treat it.
Symptoms of Shoulder Impingement
- Difficulty laying on the affected side
- Pain around the front or the side of the shoulder that may extend down the side of your arm
- Pain aggravated by overhead or behind back movements, reaching and lifting activities
Why Does Shoulder Impingement Happen?
The exact cause is unknown and some shoulder pain presentations can be insidious (no known cause), in nature. However, factors such as sudden increase in training load, poor throwing technique, repetitive overhead movements/sports and age can be associated with onset of shoulder impingement type symptoms. Activites at home that are out of the ordinary can also spark the onset of pain.
- New hobbies
- A change in career that requires arm movements above shoulder height
- Over use from work activites such as hair dressing and some trades
The shoulder is a very mobile joint, with a very large range of motion,compared to other joints in the body. This means that the ligaments and joint capsule, (that keep the shoulder in the joint), need extra reinforcement, which is provided by the muscles surrounding the shoulder. These muscles are called The Rotator Cuff, and they have an important role in stabilising the shoulder joint. They do this by helping to create a vacuum seal effect, centring the ball of the shoulder in the joint. If there is dysfunction of the rotator cuff (muscle weakness or a tendon tear) then the vacuum seal action isn’t as effective and this can alter biomechanics of the shoulder joint through movement. This can cause tendon structure changes (tendinopathy) in response to repeated stresses/compressive forces.
Treatment for Shoulder Impingement
Shoulder impingement generally responds well to conservative management strategies such as targeted exercises and Physiotherapy. In the early stages of your recovery activity modifications may be required, to help you manage your shoulder pain on a day-to-day basis. Physiotherapy treatment for shoulder impingement also consists of:
- Progressively strengthening the rotator cuff muscles
- Manual (hands on) physiotherapy to help reduce pain and improve shoulder range of movement.
Arthroscopy and subacromial decompression surgeries have been performed to increase the subacromial space to alleviate a person’s symptoms. However, research has shown there is no superior patient outcomes when surgery is compared to placebo surgery or physiotherapy. Therefore, physiotherapy should always be a patient’s first therapeutic option in this scenario, prior to a specialist review.
An assessment with a physiotherapist is a great place to start as they can make sure that other possible causes of your shoulder pain are excluded. The shoulder is a very complex area and other body areas such as your neck can refer pain into your shoulder. If you’d like to know more please contact us on 4724 0768. You can chat to one of our friendly therapists to find out if Physiotherapy is for you and book an appointment. Alternatively you can book online at a time that suits you.
Please note: the above exercise and information is general in nature. We recommend seeking individual advice before commencing any new exercises.