What does it mean when I'm told I have shoulder impingement syndrome?
Shoulder impingement syndrome is a term used to describe what happens when certain structures within the shoulder joint become intermittently jammed or compressed during movement. The structures most often involved include the subacromial bursa and/or the rotator cuff tendons. The ball and socket joint of the shoulder sits beneath another joint called your acromioclavicular joint (AC joint). The space between the two is referred to as the ‘subacromial’ space. It is within this space that the impingement of the bursa and tendons can occur, thus resulting in pain.
With normal shoulder function, the subacromial space should remain large enough throughout movement that impingement does not occur. However, for some of us, this is not the case. Most often, affected individuals will experience pain when they reach overhead, behind their back, or across their body. It is with these movements that impingement is most likely to occur. Over time, if these mechanical issues are not addressed, then it can lead to other conditions such as bursitis or tendonitis of the rotator cuff.
What is causing my shoulder impingement?
Shoulder impingement can be divided into two main categories:
- Primary (Structural) Impingement
This type of impingement is a result of structural differences in the shoulder joint. Not all joints are created equally, and as a result, some of us will just naturally have a narrower subacromial space than others. This could be caused by a decreased angle of the AC joint, or osteoarthritis which could result in the growth of bony spurs in the subacromial space. As a result of these structural changes, the bursa and rotator cuff tendons will be more susceptible to being trapped within the space during day-to-day movements.
- Secondary (Dynamic) Impingement
This type of impingement is usually a result of poor posture, joint hypermobility/instability, and/or trauma that results in muscular weakness. These issues can all result in the shoulder blade not sitting in its proper orientation, or the ball not sitting properly centred in the socket. This can ultimately result in narrowing of the subacromial space as you move through range because your body lacks the control to help stabilize the joint.
Symptoms of shoulder impingement
Common symptoms include (but are not limited to):
- Pain in the shoulder that occurs when working at shoulder height, overhead, or when reaching behind your back (e.g. reaching into a cupboard, pulling on a pair of pants, tucking in your shirt, reaching into the back seat of the car)
- Pain can radiate as far down the arm as the elbow
- Pain while sleeping on that side
- Pain or weakness with lifting, pushing, and pulling
- Pain reaching across the body (e.g. reaching for a seatbelt)
How is shoulder impingement diagnosed?
At the University of Guelph's Health and Performance Centre, our staff is well trained in the assessment of shoulder impingement syndrome. At your first appointment, your physiotherapist will run through a series of observations and tests that can help to identify the cause of your impingement. Based on your findings and your goals, you and your therapist will develop a personalized treatment plan that will help to reduce your pain and restore your function.
In some cases, your therapist or your family doctor may recommend an ultrasound of the shoulder joint. An ultrasound can be helpful in identifying shoulder impingement, as well as other conditions such as bursitis, tendonitis, and rotator cuff tears. Talk to your therapist or doctor to see if an ultrasound is appropriate for you.
Can my shoulder impingement be treated?
Physiotherapy has been shown to be very effective in the management of shoulder impingement syndrome. At the University of Guelph's Health and Performance Centre, we pride ourselves in being specialists in the management of shoulder injuries and consistently monitor the scientific research to keep up-to-date on methods of treating shoulder pain. Your treatment program (as designed with your therapist) may include: ultrasound, TENS, taping of the shoulder joint, manual therapy techniques to improve range of motion, and a progressive home exercise program that is tailored to your specific findings. Whether you’re an athlete, student, office worker, or manufacturing worker, we can help you!
If you suspect that you have shoulder impingement syndrome, give one of our clinics a call and book an appointment with one of our many qualified therapists.