Do you have pain in your shoulder with playing tennis? Swinging a hammer? Swimming? Doing your hair? You may have a shoulder impingement.
Shoulder impingement syndrome is a common cause of shoulder pain. Impingement can be caused by degenerative changes to muscles or bones in the shoulder and/or by shoulder instability and abnormal movement patterns of the joint. Pain related to impingement usually occurs on the top or front of the shoulder. This pain is generally aggravated by overhead activities such as throwing, tennis, or doing your hair.
The bony structure of the shoulder is inherently unstable and is the most commonly dislocated major joint in the body. Shoulder stability is due to a combination of ligaments, joint capsule, the labrum, and surrounding musculature of the rotator cuff and scapular (shoulder blade) rotators. The shoulder is also one of the most mobile joints in the body as it is required to reach over head and behind the back.
Primary impingement is due to degenerative changes to the muscles of the rotator cuff or changes in the acromion or coracoid process, the two bones on the “top” of the shoulder. This type of impingement is commonly seen in people over 40 and often with a history of repetitive overhead activity. Secondary impingement is due to a problem with the dynamics of the muscles stabilizing and moving the shoulder which causes abnormal movement and wear patterns, irritation of the bursa (a fluid filled sac), and is often seen with an instability of the joint. Secondary impingement occurs in a younger population, often those involved in repetitive overhead activities (such as throwing sports). Later stages of impingement can lead to biceps tendonitis or tearing of rotator cuff muscles.
Diagnosis of impingement syndrome can be made clinically based on symptoms, special tests of the shoulder for impingement, and, if necessary, diagnostic imaging to evaluate bony or structural changes in the shoulder.
Treatment for impingement syndrome has two primary phases. The first phase is to decrease pain and inflammation and the second phase is to change and restore the mechanics of the shoulder. Assessing if the shoulder is not moving properly because of mobility restrictions or poor motor control or strength is the key to determining the proper course of treatment.
Restoring the appropriate mechanics of the shoulder is achieved by an individualized program to strengthen the shoulder and scapular musculature. Stretching of short and tight muscles and joint mobilization may also be included in this phase of rehabilitation. Working to correct muscle imbalances of and surrounding the shoulder will allow the joint to again move in the ideal pattern and decrease the stresses on the irritated and impinged structures.
If you have been experiencing persistent shoulder symptoms, getting your shoulder evaluated by a physical therapist can give you a plan to return to normal function. Ascent Physical Therapy has clinics in Avon, Colorado 970-949-9966 and Eagle, Colorado 970-328-5230. Please give us a call if you have any questions regarding your shoulder.