Do you get a sharp pain in your shoulder when you are performing tasks like brushing your hair, putting on certain clothes or showering?
Is it somewhat inconsistent? Like, moving out to the side might be okay, but straight up overhead can hurt and then come and go from day to day?
Or maybe it is comfortable for part of the movement, painful at the 2/3rd mark and then sometimes pain free right up the top of the movement?
Does your shoulder “catch” with sharp pain followed by no pain as you continue to move overhead?
These are all common presentations of “Shoulder Impingement Syndrome,” a heavily debated condition as we can’t really be sure what the specific cause of pain is. We once thought it was purely biomechanical and that by improving shoulder blade movement it would fix all, but then we realised that general shoulder strength showed the same benefits.
Shoulder complaints are the third most common musculoskeletal problem after back and neck disorders. The highest incidence is in women and people aged 45–64 years. Of all shoulder disorders, shoulder impingement syndrome (SIS) accounts for 36%, making it the most common shoulder injury.
So what is it? And, more importantly, what can you do about it?
The shoulder is a wildly complex part of our musculoskeletal anatomy with our shoulder blade moving on the back of our chest all, supporting our arm to move as its primary connection to the rest of the body. We have a massive amount of range of motion because these connections are primarily muscular and ligamentous, rather than bony. Other bony joints don’t tend to have this large available range of motion!
With changes in workload at the shoulder, any of the various tissues might suffer, with tendon pathologies, bursal inflammation or labral injuries being common diagnoses. A biomechanical explanation is often that the narrow bony space between the shoulder blade and the upper arm (sub-acromial space) can move differently and result in further reduced space. This can trap the tissues passing through that space.
Although this might not be an accepted explanation in all academic circles, it fits the narrative for some people who seem to find significant improvements in their symptoms by improving their biomechanics.
While it is also true that more generalised strength training can result in similar improvements, this might not be the best fit for all. So, a one size fits all approach is often not appropriate.
Importantly, recent literature does support the use of regular joint mobilisation and specific massage therapy alongside the use of some approach to exercise, whether it be biomechanical in nature or generalised strengthening.
Shoulder pain with normal function is not normal. The injury can vary from mild tendon inflammation (tendonitis), bursitis (inflamed bursa), calcific tendonitis (bone forming within the tendon) through to partial and full thickness tendon tears, which may require surgery. Over time the tendons can thicken due to repeated irritation, perpetuating the problem as the thicker tendons battle to glide through the narrow bony sub-acromial space. The tendons can even degenerate and change in microscopic structure, with decreased circulation within the tendon resulting in a chronic tendonosis.
Accurately assessing this pathology will assist in what other adjunct approaches to therapy might be useful. Perhaps a cortisone injection, or prescribed oral antiinflammatories are appropriate? Or, in some instances other injectable options would be discussed by a Sports Physician or Orthopaedic surgeon to help your Physiotherapist guide you back to pain-free movement.
