Understanding Shoulder Impingement Syndrome

Shoulder impingement syndrome is a common cause of shoulder pain and loss of mobility. It occurs when structures in the shoulder get pinched or compressed in the narrow space between the top of the arm bone (humerus) and the bones of the shoulder blade (scapula). This compression causes irritation, inflammation, and damage to the rotator cuff tendons and bursa sacs in the shoulder joint.

Impingement has multiple causes including anatomical factors, repetitive strain from overhead activities, and muscular imbalances. Typical symptoms include shoulder pain made worse by overhead motions, stiffness, reduced range of motion, clicking sensations, and weakness. Impingement can significantly impact daily activities and quality of life if the syndrome is not properly treated.

Impingement Syndrome Treatment

Treating impingement syndrome aims first to reduce inflammation and irritation in the shoulder. Typical treatments include:

  • Rest – Avoiding activities that aggravate impingement allows inflammation to resolve.
  • Ice/Heat Therapy – Alternating cold packs and heat pads helps diminish inflammation and pain.
  • NSAIDs – Non-steroidal anti-inflammatory medications like ibuprofen help relieve discomfort.
  • Physiotherapy – Therapeutic exercises strengthen shoulder muscles and improve range of motion.
  • Corticosteroid Injections – Steroid injections given into the shoulder space can reduce inflammation.
  • Surgery – If conservative treatment fails, arthroscopic surgery may be warranted to increase space and reduce compression.

Mild cases of impingement often respond well to rest and physical therapy alone. More chronic, severe impingement may require steroid injections or surgical decompression. Most patients improve with some combination of conservative care and targeted therapies.

Can physiotherapy fix shoulder impingement?

Yes, physiotherapy is a first-line treatment option for many cases of shoulder impingement. Physiotherapy aims to:

  •   Increase the range of motion and flexibility of the shoulder joint through stretching and mobilization exercises. This reduces stiffness from inflammation.
  •   Strengthen shoulder girdle muscles, especially the rotator cuff. Stronger muscles help properly stabilize and support the shoulder, taking pressure off the compressed tendons.
  •   Improve posture and shoulder mechanics. Correcting muscular imbalances and problematic movement patterns reduces abnormal wearing of the shoulder joint.
  •   Teach safe return to activity to prevent re-injury. A gradual exercise program ensures the shoulder can tolerate normal loading and withstand force.

With professional supervision, targeted physiotherapy provides both symptomatic pain relief and helps address underlying causes of impingement like muscle weakness and poor shoulder mechanics. This facilitates recovery and reduces the risk of recurring impingement.

Shoulder Impingement Syndrome

Shoulder impingement syndrome refers to mechanical compression of the rotator cuff tendons and subacromial bursa in the shoulder’s subacromial space. When the upper arm bone and shoulder blade squeeze this area too tightly, the soft tissues become irritated and inflamed. Aggravating activities raise the arm into a position causing repetitive compression and friction, worsening damage over time.

There are two main categories of impingement syndrome:

Primary impingement is caused by altered shoulder anatomy or mobility deficits leading to abnormal impingement of tissues. Secondary impingement results from shoulder instability or underlying injury allowing improper movement and compression. Correctly categorizing the type of impingement informs appropriate treatment strategies.

Can shoulder impingement be fixed without surgery?

In many cases, shoulder impingement can be resolved without resorting to surgery. The primary non-surgical treatments include:

  • Medications – Anti-inflammatories and pain relievers help manage discomfort and swelling.
  • Injections – Cortisone shots directly into the shoulder can substantially reduce inflammation. However, their effects are temporary.
  • Immobilization – Resting the shoulder allows tissues to heal. Arm slings may be used short-term.
  • Physical therapy – PT focuses on shoulder strengthening, range of motion improvement, and correcting muscle imbalances. This addresses the source of problems.
  • Lifestyle modification – Adjusting activities to avoid straining the injured area helps prevent worsening.

What causes impingement syndrome?

There are several contributing factors to shoulder impingement syndrome:

  •   Repetitive overhead motions like reaching, lifting, and throwing – These repetitive actions cause mechanical compression and rubbing of the shoulder structures.
  •   Structural abnormalities – Hooked acromion shape, calcium deposits, and bone spurs can constrict the subacromial space.
  •   Poor posture – Slumped shoulders bring the acromion closer to the humerus, narrowing space.
  •   Muscle imbalances – Weak rotator cuff muscles allow improper shoulder movements that impinge tissues.
  •   Trauma or injury – Falls or blows to the shoulder may damage tissues, leading to impingement.
  •   Age – Impingement is more common over 40 as tendons stiffen and acromion bones enlarge.

What are the common symptoms?

  •   Shoulder pain worsened by reaching overhead or behind the back
  •   Stiffness and reduced shoulder mobility
  •   Difficulty lifting the arm due to pain or weakness
  •   Dull, aching pain at rest that disrupts sleep
  •   Popping, grinding, or catching sensations when moving the arm
  •   Pain radiating down the outer arm from irritated nerves
  •   Tenderness and possible swelling around the shoulder joint

Seeking treatment for worsening shoulder pain and mobility issues can prevent severe injury from impingement syndrome.

Conservative therapies like these often successfully treat impingement without surgery when applied consistently under a doctor’s supervision. Approximately 70% of patients see improvement with non-operative treatments. Surgery may still be required if immobilization, therapy, and injections do not adequately resolve pain and disability.