Shoulder Impingement

Shoulder Impingement
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What is shoulder impingement?

The most common cause of shoulder pain when lifting your arm above your head is referred to as shoulder impingement. Shoulder impingement can be due to an acute or overuse bursitis or a rotator cuff tendinopathy, or both.

Between the shoulder joint (gleno-humeral joint) and the roof of the shoulder (acromion) is an area called the subacromialspace. Inside this space lie the rotator cuff tendons, the long head of biceps tendon and a bursa known as the subacromial bursa. If there has been injury to the tendons or bursa these structures can become impinged when we lift our arm up due to swelling or inflammation.

Shoulder Impingement

What are the signs and symptoms of shoulder impingement?

The most common symptom is pain with movement, particularly elevation and rotation of the arm. It can also occur when loading the shoulder by lifting heavy objects. Patients often complain of loss of motion and power due to pain inhibition. In more severe cases people experience night pain which disturbs their sleep.The pain is often localised to the upper and outer area of the shoulder and upper arm and may extend to the elbow.

Who gets shoulder impingement?

Anyone can get shoulder impingement at any age, however it is more common in people who are required to perform repetitive overhead tasks. Shoulder impingement is also more common the older we get due to the rotator cuff becoming weaker and more degenerative and likely to be more swollen and inflamed.

What is the physiotherapy management?

During the initial phase management will be aimed at controlling symptoms. This may include rest from aggravating movements, taping for support, ice therapy and anti-inflammatory medication (always consult with your doctor or pharmacist before taking any medications). Once the symptoms have settled, any posture or motor control deficits that are contributing to the impingement will be addressed. Typically postural control and scapular control exercises are prescribed. Muscle release techniques and stretches are also utilised to overcome motor control and range of motion deficits.

Are investigations useful?

Diagnosis is made primarily through the clinical examination. Investigations are often recommended to rule out other causes of shoulder pain such as frozen shoulder in long standing cases, as frozen shoulder behaves very similarly to impingement in the early stages. X-ray can be used to rule out a hooked acromion or spur as the cause of impingement. US or MRI will provide information regarding the soft tissues, such as bursitis or rotator cuff tendinopathy. 

How long will it take to resolve?

Physiotherapy is important for obtaining an accurate diagnosis and appropriate treatment for pain free shoulder range of motion and function. Full recovery can take between 3 to 6 months, however a prompt physiotherapy regime can accelerate the process.

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