Shoulder Impingement Syndrome

Types of shoulder impingement

A healthcare provider might classify shoulder impingement as a more specific issue, including:

• Rotator cuff tendinitis: Tendinitis is swelling or irritation of a tendon. Four tendons support your rotator cuff and help it move your shoulder joint. Anything that irritates or damages them can cause swelling and impingement.

• Shoulder Bursitis: Bursitis is inflammation of a bursa. These are fluid-filled sacs that line some of your joints. A bursa cushions the space between your rotator cuff tendons and shoulder blade. Swelling from bursitis can lead to impingement.

• Acromion deformity: The top of your shoulder blade is called the acromion. It’s usually flat. But it can rub or pinch your rotator cuff if it’s curved or hooked. Yours might have a naturally different shape from birth. You might also develop bone spurs on it as you age.

Symptoms and Causes

Symptoms of shoulder impingement syndrome

Shoulder pain is the most common symptom. The pain usually feels like it comes from the front of your shoulder. It may also:

• Make your shoulder feel tender

• Spread from the front of your shoulder to the side of your arm

• Get worse at night or affect your sleep

Pain may get worse during certain movements or positions, including when you:

• Extend your arm up, above your head

• Lift and lower your arm

• Reach for something

• Lay on the injured side of your body

• Reach behind your back, like twisting to unzip a purse or backpack

Rotator cuff tendinitis symptoms

You might experience different symptoms depending on which type of shoulder impingement you have. For example, rotator cuff tendinitis symptoms can also include:

• Stiffness

• Swelling

• Skin discoloration

• Hearing or feeling a crack or pop when you move your shoulder

Shoulder impingement causes

Shoulder impingement is almost always an overuse injury. This means it happens over time when an activity or motion repeatedly puts too much stress on your shoulder.

Overhead rotation motions where you twist and turn your shoulders with your arms raised can cause impingement. Training for a sport or doing the same type of movement all day at work are the most common causes.

You might have shoulder impingement without an obvious cause. It’s also possible for trauma — like a fall, car accident or sports injury — to cause sudden impingement.

Shoulder impingement risk factors

Anyone can experience shoulder impingement. Athletes and people who do physical work are more likely to. It usually develops slowly over weeks or months.

Sports that can cause shoulder impingement include:

• Swimming

• Baseball

• Volleyball

• Tennis

Any physical job that puts pressure on your shoulders can lead to impingement, including:

• Construction

• Painting

• Washing windows

• Hanging wallpaper or drywall

Diagnosis and Tests

How Physiotherapists diagnose this condition

A healthcare provider will diagnose shoulder impingement with a physical exam. They’ll examine your shoulder and check your range of motion. Tell your provider what you were doing when you first noticed symptoms. Tell them about your hobbies, work or sports if you use your shoulders a lot.

Your provider might use imaging tests, including:

• Ultrasound Scan

• MRI scan: if suspected complex conditions with impingement.

These will help your provider see the bones and tissue in your shoulder. They’ll also help them rule out other causes of shoulder pain, including:

• Rotator Cuff tears

• Bicep tendon injuries

• Shoulder arthritis

Management and Treatment

Conservative Management:

• Rest: You’ll need to take break from physical activity, especially the sport or activity that caused impingement.

• Life Style Modification: Avoid sleeping on the affected side, carrying heavy bags on the affected side.

• Physical therapy: A physical therapist will give you stretches and exercises to strengthen your shoulder and improve its range of motion. They’ll help you strengthen the muscles in your rotator cuff as your shoulder heals.

• Icing: Apply ice or a cold pack to your shoulder. Wrap ice packs in a thin towel to avoid putting them directly on your skin. Your provider will tell you how often you should ice your shoulder.

• Pain relievers: Over-the-counter NSAID's (Ibuprofen) can relieve pain and reduce swelling or topical pain relief gel. Don’t take them for more than 10 days in a row without talking to your provider.

Self Awareness/Self Assessment for Patients:

• Advise the patient to understand their shoulder movements that are painful and their recovery pattern.

• Begin with identifying painful arc movement on abduction of shoulder.

• Progress to identify all the range of movement's of shoulder-Flexion/Extension, Abduction/Adduction, Internal/External Rotation

Unresolved pain with conservative management:

• Corticosteroids: These are prescription anti-inflammatory medications. You may need steroid shots in your shoulder joint.

• Surgery: Your provider might recommend surgery if other treatments don’t work. Your surgeon might remove part of your shoulder blade to create more space for your rotator cuff.

Rotator cuff tendinitis treatments usually include all the same treatments for other types of shoulder impingement. Your provider will suggest the best ways to help your rotator cuff tendons heal.

Exercise Plan for Phase 1 of Rehab.