What are the Symptoms of Shoulder Impingement?
Commonly rotator cuff impingement has the following symptoms:
▪ An arc of shoulder pain approximately when your arm is at shoulder height and/or when your arm is overhead
▪ Shoulder pain that can extend from the top of the shoulder down the arm to the elbow
▪ Pain when lying on the sore shoulder, night pain and disturbed sleep
▪ Shoulder pain at rest as your condition worsens
▪ Muscle weakness or pain when attempting to reach or lift
▪ Pain when putting your hand behind your back or head
▪ Pain reaching for the seat-belt, or out of the car window for a parking ticket
Who Suffers Shoulder Impingement?
Impingement syndrome is more likely to occur in people who engage in physical activities that require repeated overhead arm movements, such as tennis, golf, swimming, weight lifting, or throwing a ball. Occupations that require repeated overhead lifting or work at or above shoulder height also increase the risk of rotator cuff impingement.
How is Shoulder Impingement Diagnosed?
Shoulder impingement can be diagnosed by your Physiotherapist using some specific manual tests. An ultrasound scan may be useful to detect any associated injuries such as shoulder bursitis, rotator cuff tears, calcific tendonitis or shoulder tendinopathies. An x-ray can be used to see any bony spurs that may have formed and narrowed the sub-acromial space.
What does the Treatment Involve?
There are many structures that can be injured in shoulder impingement syndrome. How the impingement occurred is the most important question to answer. This is especially important if the onset was gradual, since your static and dynamic posture, muscle strength, and flexibility all have important roles to play. Your rotator cuff is an important group of muscles that control and stabilise the shoulder joint. It is essential the muscles around the thoracic spine and shoulder blade are also assessed and treated as these too work together with the entire shoulder girdle.
To effectively rehabilitate this injury and prevent recurrence, you need to work through specific stages with your therapist.
These stages may include:
1. Early Injury: Protection, Pain Relief & Anti-inflammatory Treatment
2. Regain Full Shoulder Range of Motion
3. Restore Scapular Control and Scapulohumeral Rhythm
4. Restore Normal Neck-Scapulo-Thoracic-Shoulder Function, including posture correction
5. Restore Rotator Cuff Strength
6. Restore High Speed, Power, Proprioception and Agility Exercises
7. Return to Sport or Work
The early stages of treatment will involve manual therapy, including massage to relieve pain and release tight structures as well as mobilisation techniques to restore normal shoulder movement. Strapping/taping has been shown to be helpful in reducing pain as well as ultrasound and laser therapy. As you move through the other stages of treatment your therapist will prescribe rehabilitation exercises specific to your shoulder, posture, sport and/or work demands.
Corticosteroid injections can be useful in the initial pain relieving stage if conservative (non-surgical) methods fail to reduce the pain and inflammation. It is important to note that once your pain settles, it is important to assess your strength, flexibility, neck and thoracic spine involvement to ensure that your shoulder impingement does not return once your injection has worn off.
Some shoulder impingements will respond positively and quickly to treatment; however many others can be incredibly stubborn and frustrating, taking between 3-6 months to resolve. There is no specific time frame for when to progress from each stage to the next. It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and frustration. For more specific advice about your shoulder impingement, contact your Physio!
