Navigating Shoulder Impingement: Types, Causes, and Treatments, and the Role of Physiotherapy
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on July 15, 2024
Shoulder impingement syndrome is a common condition that occurs when the tendons or bursa in the shoulder are compressed or pinched during arm movements. This can lead to pain, inflammation, and limited range of motion. It typically affects individuals who engage in repetitive overhead activities, such as athletes, manual laborers, and even those with certain postural habits.
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Understanding shoulder impingement syndrome is crucial for effective treatment. Recognizing the signs and symptoms early can prevent the condition from worsening and help individuals maintain shoulder function and overall quality of life. Early intervention through physiotherapy, exercise modification, and in some cases, medical treatment, can significantly improve outcomes and reduce the risk of chronic shoulder problems (Lewis, 2016; Michener et al., 2013).
What is shoulder impingement syndrome?
Shoulder impingement syndrome, also known as subacromial impingement syndrome, refers to a condition where the tendons of the rotator cuff and the subacromial bursa become compressed and irritated as they pass through the subacromial space of the shoulder joint. This compression often occurs during overhead activities or movements that involve raising the arm, leading to pain and inflammation in the shoulder.
Overview of the shoulder joint structure and how impingement occurs
The shoulder joint is a complex structure composed of the humerus (upper arm bone), the scapula (shoulder blade), and the clavicle (collarbone). The head of the humerus fits into a shallow socket in the scapula called the glenoid cavity, forming the glenohumeral joint. Surrounding this joint are muscles, tendons, ligaments, and the subacromial bursa, which help stabilize and facilitate movement of the shoulder.
Impingement syndrome typically occurs when there is narrowing of the subacromial space due to various factors such as structural abnormalities (e.g., bone spurs), overuse or repetitive movements (e.g., throwing or swimming), poor posture, or muscular imbalances. As the arm is raised, particularly in overhead positions, the space between the acromion (a bony projection of the scapula) and the humeral head narrows, leading to compression and friction on the tendons and bursa. This repetitive compression can cause irritation, inflammation, and eventual damage to the structures within the subacromial space, resulting in shoulder pain and functional limitations.
Understanding the anatomical and biomechanical factors contributing to shoulder impingement syndrome is essential for accurate diagnosis and effective management strategies, including physiotherapy interventions aimed at improving shoulder mechanics, reducing inflammation, and restoring pain-free movement.
Causes of shoulder impingement syndrome
Shoulder impingement syndrome can arise from several contributing factors:
Overuse and repetitive overhead activities: Activities that involve repetitive overhead motions, such as throwing, swimming, or overhead lifting, can strain the tendons and bursa in the shoulder joint, leading to irritation and inflammation
Anatomical factors: Structural abnormalities, such as bone spurs (osteophytes) or variations in the shape of the acromion process, can reduce the subacromial space. This narrowing increases the likelihood of tendon impingement during arm movements
Poor posture and biomechanics: Incorrect posture or biomechanics during activities can alter the shoulder's mechanics, placing excessive stress on the tendons and bursa over time.
Weakness or imbalance in shoulder muscles: Weakness or imbalance in the muscles supporting the shoulder joint, particularly the rotator cuff muscles, can affect shoulder stability and contribute to impingement symptoms.
Previous shoulder injuries: Prior shoulder injuries, such as a rotator cuff tear or shoulder dislocation, can alter shoulder mechanics and increase the risk of developing impingement syndrome.
Understanding these causative factors is crucial for both prevention and treatment strategies aimed at addressing the underlying mechanisms contributing to shoulder impingement syndrome.
Signs and symptoms of shoulder impingement syndrome
Shoulder impingement syndrome manifests with several characteristic signs and symptoms:
Pain when lifting the arm: Individuals may experience pain, especially when raising their arm above shoulder height, such as during reaching or lifting activities
Shoulder pain that worsens at night: Pain often intensifies during rest, particularly when lying on the affected shoulder, which can disturb sleep patterns.
Weakness in the shoulder and arm: Muscular weakness in the shoulder and upper arm can accompany impingement syndrome, affecting daily activities and functional tasks.
Limited range of motion: Reduced ability to move the shoulder through its full range of motion, particularly in overhead or rotational movements, is common.
Tenderness or swelling at the front of the shoulder: Localized tenderness or swelling may be present over the front of the shoulder joint, indicating inflammation of the affected structures.
Prevention of shoulder impingement syndrome
Preventive measures can help reduce the risk of developing shoulder impingement syndrome:
Proper warm-up and stretching: Engaging in a thorough warm-up routine and incorporating stretching exercises before physical activities can improve muscle flexibility and joint mobility
Strengthening exercises: Regularly performing strengthening exercises targeted at the shoulder and upper body muscles, especially the rotator cuff muscles, can enhance shoulder stability and support.
Maintaining good posture and ergonomics: Adopting and maintaining proper posture during daily activities and ensuring ergonomic adjustments in work environments can alleviate undue stress on the shoulder joints.
Avoiding repetitive stress and heavy lifting: Minimizing repetitive overhead movements and avoiding heavy lifting without proper technique can help prevent overuse injuries.
Using proper techniques in sports and exercise: Practicing correct techniques and employing appropriate equipment during sports and exercise activities can mitigate the risk of shoulder injuries.
Implementing these preventive strategies can promote shoulder health and reduce the likelihood of developing impingement syndrome.
Diagnostics of shoulder impingement syndrome
Diagnosing shoulder impingement syndrome typically involves a combination of methods:
Physical examination: Healthcare professionals conduct a thorough physical examination to assess shoulder range of motion, strength, and signs of inflammation or tenderness.
Patient history and symptom discussion: Gathering information about the onset, duration, and specific characteristics of shoulder pain, as well as any previous injuries or activities that may contribute to the condition.
Imaging tests: X-rays, MRI (Magnetic Resonance Imaging), and ultrasound are commonly used to visualize the shoulder joint, assess structural abnormalities like bone spurs or tendon inflammation, and rule out other potential causes of shoulder pain.
Special diagnostic tests: Tests such as the Neer test and Hawkins-Kennedy test are specific maneuvers used during physical examination to reproduce symptoms and assess impingement of the tendons within the subacromial space.
Treatment options for shoulder impingement syndrome
Treatment strategies for shoulder impingement syndrome aim to alleviate pain and inflammation, improve shoulder function, and prevent recurrence:
Initial pain management: This may include over-the-counter or prescription medications to manage pain and inflammation, as well as ice or heat therapy to reduce swelling.
Rest and activity modification: Temporarily avoiding activities that exacerbate symptoms and modifying daily routines to protect the shoulder joint.
Physical therapy exercises: Prescribed exercises focus on strengthening the rotator cuff and shoulder muscles, improving flexibility, and correcting posture and biomechanics.
Manual therapy and chiropractic adjustments: Techniques such as manual therapy or chiropractic adjustments may help improve joint mobility and reduce pain.
Corticosteroid injections: Injections of corticosteroids into the subacromial space can provide temporary relief of inflammation and pain.
Surgical interventions: For severe cases that do not respond to conservative treatments, surgical options like subacromial decompression may be considered to create more space for the tendons and bursa within the shoulder joint.
Physiotherapy for shoulder impingement syndrome
Physiotherapy plays a crucial role in the comprehensive management of shoulder impingement syndrome, focusing on restoring shoulder function, reducing pain, and preventing recurrence through targeted interventions.
How physiotherapy helps in recovery
Physiotherapy for shoulder impingement syndrome aims to address underlying biomechanical issues, strengthen supporting muscles, and improve joint flexibility. By implementing tailored exercise programs and manual therapy techniques, physiotherapists can enhance shoulder mobility and stability, alleviate pain, and promote optimal healing (Littlewood et al., 2013).
Types of physiotherapy exercises and treatments used
Strengthening exercises: Targeting the rotator cuff and shoulder muscles to improve strength and stability around the joint.
Range of motion exercises: Including stretches and movements to increase shoulder flexibility and restore normal joint mechanics.
Manual therapy: Techniques such as mobilization or soft tissue massage to reduce muscle tension, improve circulation, and enhance joint mobility.
Modalities: Such as ultrasound or electrical stimulation may be used to reduce pain and inflammation in conjunction with exercise therapy.
Benefits of physiotherapy
Physiotherapy can significantly benefit individuals with shoulder impingement syndrome by:
Improving mobility: Restoring normal range of motion and flexibility in the shoulder joint.
Increasing strength: Strengthening muscles to support and stabilize the shoulder, reducing the risk of further injury.
Reducing pain: Alleviating pain through targeted exercises and manual techniques, promoting better functional outcomes (Castelein et al., 2014).
Success stories or case studies
Research and case studies have demonstrated the effectiveness of physiotherapy in treating shoulder impingement syndrome. Patients often report reduced pain, improved shoulder function, and enhanced quality of life following structured physiotherapy interventions (Bennell et al., 2010).
Conclusion
Importance of recognizing and treating shoulder impingement syndrome
Recognizing and treating shoulder impingement syndrome promptly is crucial for several reasons:
Prevention of progression: Early intervention can prevent the condition from worsening, reducing the risk of chronic pain and functional limitations.
Improved outcomes: Timely treatment facilitates quicker recovery, restoring shoulder mobility and strength effectively.
Enhanced quality of life: Managing symptoms early can improve overall quality of life by minimizing pain and discomfort associated with shoulder impingement syndrome.
Encouragement to seek professional help
If you experience symptoms such as shoulder pain during movement or at rest, weakness, or limited range of motion, seeking professional help from a physiotherapist or healthcare provider is essential. Early diagnosis and appropriate treatment can make a significant difference in managing and resolving shoulder impingement symptoms.
Contact our physiotherapy clinic today to schedule a consultation if you suspect you may have shoulder impingement syndrome or are experiencing related symptoms. Our experienced physiotherapists can provide a comprehensive assessment, personalized treatment plan, and ongoing support to help you recover and regain full function of your shoulder.
References:
Hegedus, E. J., Goode, A. P., Cook, C. E., et al. (2012). Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. British Journal of Sports Medicine, 46(14), 964-978. https://doi.org/10.1136/bjsports-2012-091066
Kuhn, J. E. (2009). Exercise in the treatment of rotator cuff impingement: A systematic review and synthesized evidence. Journal of Shoulder and Elbow Surgery, 18(1), 138-160. https://doi.org/10.1016/j.jse.2008.06.004
Related links:
Navigating Shoulder Injuries: Types, Causes, and Treatments, and the Role of Physiotherapy
Understanding Frozen Shoulder: Types, Causes, and Treatments, and the Role of Physiotherapy
Navigating Rotator Cuff Tear: Types, Causes, and Treatments, and the Role of Physiotherapy
Navigating Shoulder Dislocation: Types, Causes, and Treatments, and the Role of Physiotherapy
Understanding Shoulder Pain: Types, Causes, and Treatments, and the Role of Physiotherapy
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.