Shoulder Impingement
Shoulder impingement syndrome occurs when the rotator cuff tendons and the sub-acromial bursa are compressed within the sub-acromial space.
Understanding Shoulder Impingement
Anatomy of the Shoulder
Rotator Cuff Muscles
A group of 4 small muscles run from the shoulder blade to the top of the arm bone from a rotator cuff tendon. To get to the arm bone the tendon passes through the sub-acromial space.
Subacromial Space
The sub-acromial space is a narrow space between the accordion and the top of the upper arm bone (humerus). Located in this space are the rotator cuff tendons and the subacromial bursa (a sack of fluid that acts as a cushion).
Causes of Shoulder Impingement
Anything which causes narrowing of the sub-acromial space will cause the tendon and bursa to become impinged.
Possible causes of sub-acromial narrowing and shoulder impingement include:
Inflammation in the sub-acromial space caused by trauma
Boney spurs or variations in the shape of the acromion
Overuse – often due to repetitive reaching overhead or lifting
Thickening or calcification of the coraco-acromial ligament
Poor mechanics of the shoulder blade and arm during movement – often caused by weakness of the shoulder stabilizing muscles
Signs and Symptoms
Pain in the top of the arm usually worsens if you try to lift your arm up in the air.
Pain may occur at rest and be worse at night particularly if lying on the affected shoulder
Activities that worsen the symptoms include lifting, putting up washing, overhead arm activities, pushing down through the arm, lying on the shoulder
Movement may be restricted by pain and be associated with clicking or a painful arc
Assessment
Management
Reducing Symptoms in the Acute Phase
In this phase different treatments are used to reduce pain and maintain function.
These may include:
- Use of ice to reduce inflammation
- Taping to correct biomechanics of the shoulder or off load rotator cuff muscles
- Soft tissue massage and trigger point therapy to reduce tone in the rotor cuff muscles and maintain mobility of the tissues
- Joint mobilization used to improve the alignment of the joints and reduce the potential for impingement
- Dry needling may be useful to reduce muscle tone around the shoulder and promote better biomechanics
- Stretches both in the treatment room and at home form an important part of this phase
- Activity modification in daily activities and at work
- Treatment of the neck may be indicated where this is a component of the problem
Rehabilitation and Return to Function
This phase begins as acute symptoms are settling and movement is improving. It may include some of the following modalities:
- Hydrotherapy
- Physio Group Exercise based strengthening
- Home exercise program of stretching and strengthening
- Functional retraining for return to work or sport – these training needs to strengthen around the shoulder in movement patterns which simulate these activities
- Functional retraining for return to work or sport – these training needs to strengthen around the shoulder in movement patterns which simulate these activities
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