Shoulder Pain Or Possibly Impingement Syndrome

If you are experiencing shoulder pain, especially with repetitive movements at shoulder level or overhead you may be suffering from shoulder impingement syndrome.

The shoulder is a very complex joint that provides great mobility; however, at the same time can lack stability. The shoulder consists of 3 bones: Scapula (shoulder blade), humerus (upper arm bone) and the clavicle (collar bone). Connecting and helping stabilize these three bones is the rotator cuff. The rotator cuff consists of 4 muscles; supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles function to abduct (raise) and rotate the arm. As the arm is raised, the rotator cuff snugs the humeral head into the glenoid (socket) of the scapula. The superior aspect of the scapula forms the “roof” and is referred to as the acromion. There is also a bursa located between the acromion and rotator cuff tendons. This serves to decrease friction between the 2 aforementioned structures.

Common causes of shoulder impingement may be everyday activities that involve using the arm overhead, sports such as basketball, tennis, or volleyball, anatomical factors (bone spurs), or direct trauma. What occurs with repeated overhead movements is that as the arm is raised (especially overhead) the space between the humeral head and the acromion becomes smaller, impinging the rotator cuff tendons. This in turn causes the rotator cuff to become inflamed and swollen, leading to tendonitis. The same can occur at the previously mentioned subacromial bursa, leading to bursitis.

Symptoms in the early stages may be generalized aches and pains, that may radiate into the elbow. In the beginning, pain occurs whenever the arm is raised overhead. Most people are pain free at rest, but may experience and/or be awakened at night if sleeping on the involved side. With time and continued aggravating motions, the arm will become weak and motion limited. If left untreated fibers of the rotator cuff can suffer small tears, progressing to a full-thickness tear or avulsion of the tendon from the bone, the latter requiring surgical intervention.

Treatment usually begins with a visit to your general or orthopedic doctor. Initially, your doctor may prescribe non surgical intervention, including anti-inflammatory medication and a script for physical therapy. Upon you initial visit to physical therapy you will undergo and evaluation to assess your limitations. (e.g. range of motion, strength, pain and function). After which, a plan of care will be established with the main goal being to relieve pain and inflammation, prevent muscle atrophy, re-establish non painful range of motion and return to full function. Physical therapy offers specific exercises to strengthen the rotator cuff muscles and scapular stabilizers in adjunct to modalities, such as phonophoresis, iontophoresis, low level laser, electrical stimulation, and ice to help decrease pain and inflammation. Manual therapy techniques, including passive range of motion, joint mobilizations and stretching may also be implemented to restore full range of motion. This condition often responds very favorably to physical therapy. However, if unsuccessful, you and your doctor may consider other treatment options such as injections and/or surgical intervention.

If you have any questions or concerns pertaining to the aforementioned condition, you may feel free to contact Progressive Physical Therapy at 304-788-7816.

Article submitted by Eli Rhodes, MPT