Shoulder pain is one of the most common physical pains; a fun sports day on the weekend or trying a new arm workout at the gym can cause it to become painful. The shoulder is composed of several joints, tendons, and muscles that allow your arm to move freely. Any pinching in joints can cause shoulder impingement.
In this guide, we will discuss common symptoms, causes, and treatment plans for shoulder impingement to help you manage your pain and find relief.
What is shoulder impingement?
Shoulder impingement, also known as impingement syndrome or shoulder impingement syndrome, happens when the top outer edge of your shoulder blade (scapula) pinches your rotator cuff underneath. In medical terms, impingement means rubbing or pinching inside a joint. It causes pain, especially when you move.
Your rotator cuff is made up of four muscles that connect your shoulder blade to your upper arm bone, or humerus. It helps you lift your arm overhead and rotate it toward and away from your body. The rotator cuff exists in the blade socket between your humerus and the acromion, the top part of your shoulder blade. This can put your rotator cuff at risk of being squeezed between these bones, a condition known as shoulder impingement.
What is the prevalence of shoulder impingement?
About half of shoulder pain cases are diagnosed as shoulder impingement. It is common among athletes and physically demanding workers.
What signs of shoulder impingement should alert you?
Some common symptoms of the shoulder impingement are:
- Shoulder pain: your shoulder might feel tender upon touching
- Pain and stiffness when you try to lift your arm above your head
- Sharp pain when bringing your arm down or during any activity
- Worst pain at night at the top and the outside of your shoulder
- Dull or diffuse pain while lying down to rest
- Weakness of shoulder muscles and arms
As the pain gets severe, symptoms might be:
- Inability to sleep because of severe pain
- Loss of strength and motion
- Pain during regular activities such as washing, getting dressed, or putting on a seatbelt
These symptoms can be mistaken for other shoulder or neck pains, so it is advised to get a proper diagnosis.
What is causing shoulder impingement?
The causes of shoulder impingement symptoms can be structural (Anatomic predisposition), functional (a specific activity you performed), or both. The most common causes of both are:
- Overuse or hyperextension happens when you put too much pressure on your shoulder joint or rotator cuff through repetitive movement. It mainly occurs during frequent overhead arm motions, such as those involved in sports or work activities, which can lead to tendinopathy and impingement syndrome.
- Underuse occurs when you lack adequate exercise or have abnormal movements of your shoulder blade. This weakens the muscle and puts strain on tendons.
- Poor posture: Repeated slouching tends to change the alignment of the shoulder joint and make one more susceptible to impingement.
- Traumatic injury occurs when you fall, get into a car accident, or suffer a sports injury, causing soft tissue inflammation, which becomes impinged within a joint.
- Rotator cuff pain occurs in athletes who use their arms frequently for swimming, baseball, tennis, etc.
- Scapular dyskinesis: When the scapula malposition occurs in an incorrect position, commonly protruding abnormally, leading to aberrant movement and, at times, impingement.
How will your doctor diagnose shoulder impingement?
Your doctor will make a diagnosis based on your medical history, physical examination of your shoulder and neck, and imaging tests to confirm the diagnosis.
The physical examination for shoulder impingement includes the following tests. If either causes pain, the diagnosis is positive:
- Neer impingement shoulder test: Your physician puts your arm down and stabilizes your shoulder blade, then slowly raises your arm in a forward semicircle. If you experience pain, it indicates impingement.
- Hawkins-Kennedy test: The physician will place your upper arm directly forward and at right angles to your body with your elbow bent towards your chest at 90 degrees. Holding your top arm at the elbow, the physician will then push down on your forearm to passively rotate your shoulder inward.
Your doctor will order imaging tests to identify whether symptoms are caused by different conditions that may overlap with or be separate from impingement, such as shoulder arthritis, bursitis, rotator cuff tendinopathy, and cervical radiculopathy. These imaging tests may include X-rays, MRI scans, or ultrasounds.
What treatment options might your doctor recommend for shoulder impingement?
Nonsurgical treatment
Your doctor will suggest a treatment plan that helps manage your Shoulder impingement symptoms. It will include:
- Rest: Resting and taking a break from physical activity, especially the activity or sport that led to the impingement.
- Physical therapy: A physical therapist will give you stretches and exercises to strengthen your shoulder and improve its range of motion.
- Icing: Put ice or a cold pack on your shoulder.
- Pain medications: your doctor will recommend over-the-counter NSAIDs to stop pain and swelling.
- Corticosteroids: Will help reduce your inflammation, or you might need cortisone shots directly into your shoulder joint.
Surgical treatment
If your shoulder impingement requires surgery, your doctor will suggest one of the following:
- Arthroscopic shoulder decompression to remove part of your acromion to create more space for your rotator cuff.
- Bursectomy to remove the inflamed portion of the bursa.
Rehabilitation:
After your surgery, your doctor will recommend rest and taking breaks to allow your arm and shoulder to heal properly. The doctor may suggest wearing a sling for a short time. The doctor will recommend exercises to regain motion and strengthen the shoulder.
Which preventive steps should you consider?
The following are some steps you can follow to prevent shoulder impingement in the future:
- Warm up before you exercise.
- Stretch after exercise.
- Stop playing or working out if you feel pain in your shoulder.
- Maintain good posture, especially during work and physical activities.
- Wear the appropriate equipment for sports and physical activities
Living with
Anything that irritates your rotator cuff and the soft tissues in your shoulder joint can lead to shoulder impingement. Suppose you have rotator cuff tendinitis, bursitis, or an underlying problem with your shoulder bones. In that case, your doctor will suggest a combination of treatments that reduce your symptoms and help restore your normal range of motion.
Shoulder impingement can be painful and frustrating, especially if it causes you to miss weeks of your favourite sport or activity. However, don’t ignore symptoms such as pain, tenderness, or difficulty moving your shoulder. The sooner you get your shoulder checked by a healthcare professional, the sooner you can get back to doing what you enjoy safely.
Conclusion
Shoulder impingement can limit your daily activities and affect your quality of life if left untreated. Most people recover well with prompt diagnosis, proper treatment, and preventive care. If you experience persistent pain or difficulty moving your shoulder, consult a healthcare provider promptly to prevent long-term issues and safely return to your routine.
Frequently Asked Questions?
How soon after treatment will I feel better?
Most people with shoulder impingement experience improvement in a few weeks after starting treatment. Don’t go back to playing sports or doing any intense physical activity until your provider says it’s safe, even if your symptoms improve.
Is Surgery Necessary?
Surgery is not necessary in most cases of shoulder impingement syndrome. If symptoms persist despite adequate non-operative treatment, surgical intervention may be beneficial.
What Are the Side Effects of Impingement Syndrome Treatment?
Upset stomach, indigestion, and headaches are common side effects of oral anti-inflammatory medications. However, taking these drugs with food or after meals can help reduce stomach upset. Anti-inflammatory drugs may also cause vomiting, constipation, and stomach bleeding (ulcers), although these side effects are less common. The side effects of cortisone shots vary depending on the dose and frequency of injections. Common side effects from cortisone pills include elevated blood sugar, decreased resistance to infection, weight gain, osteoporosis (thinning of the bones), skin thinning, cataracts, and high blood pressure.
