Understanding your Shoulder Diagnosis: What is Shoulder Impingement Syndrome?

Shoulder impingement is a bit of a of a misnomer because impingement occurs every time we raise the arm. It does not become a condition until pain occurs with the motion. Shoulder impingement syndrome by definition is when the movement of the scapula and humerus becomes aberrant and causes pain the joint. The subacromial space, the space between the acromion of the scapula and humerus which the rotator cuff is present, decreases and “impinges” on the rotator cuff. The rotator cuff becomes irritated because of the increased rubbing and pinching. Prolonged irritation can cause tendonitis and even a rotator cuff tear. The subacromial bursa, a fluid filled sac that secretes lubricant for the shoulder, can also become inflamed and thicken during impingement syndrome. 

The condition can occur because of an acute injury or a gradual onset of pain. Overhead activities are particularly difficult because of a painful arc that is usually present from 60-120 degrees of elevation. Reaching behind the back is the other motion that will become restricted. Pain will usually start with active motion but progress to become a constant feeling that is present at rest. Weakness and loss of motion will worsen as irritation increases.

Shoulder impingement syndrome is diagnosed through a physical exam. Neer sign and Hawkins-Kennedy Test are movement based tests that are utilized by the practitioner to determine if impingement is the cause of the should pain. An x-ray is performed to rule out arthritis or other possible problems of the bone and a MRI is utilized to rule out a rotator cuff tear. 

Physical therapy is the most common method to treating shoulder impingement. A therapist will determine if the condition is being caused by muscle imbalances, poor posture, reduced humeral stability, or rotator cuff weakness. Scapular positioning and stability also plays a large role in improving the subacromial space. A combination of stretching, strengthening, and modalities are utilized to regain normal strength and motion. Acupuncture is increasing being utilized to reduce symptoms in conjunction with physical therapy to speed the recovery. Over the counter oral anti-inflammatory medications are used to assist with reducing swelling or pain. A doctor may utilize cortisone injections to further reduce swelling. On very rare occasions surgery is recommended because the outcomes in the short term and long term are better with conservative measures.

If you want to learn more about what we can do about your shoulder, contact us here

Works Cited

Johansson, Kajsa, et al. “Subacromial Corticosteroid Injection or Acupuncture with Home Exercises When Treating Patients with Subacromial Impingement in Primary Care-a Randomized Clinical Trial | Family Practice | Oxford Academic.” OUP Academic, Oxford University Press, 4 Mar. 2011, academic.oup.com/fampra/article/28/4/355/507337/Subacromial-corticosteroid-injection-or.’

Kromer, Thilo O., et al. “Effects of Physiotherapy in Patients with Shoulder Impingement Syndrome: A Systematic Review of the Literature.” Latest TOC RSS, Medical Journals Limited, 1 Oct. 2009, www.ingentaconnect.com/content/mjl/sreh/2009/00000041/00000011/art00003.

Posted in: Physical Therapy, Shoulder

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