According to the University of New South Wales, the shoulder is the third most commonly injured body region amongst all Australians.[1] Estimates calculate that approximately 200,000 Australian adults will suffer from shoulder pain. Of which, approximately 44-65% of cases are caused by shoulder impingement.[2]
While shoulder impingement might be the underlying reason for shoulder pain, it is usually caused by other underlying conditions. Rotator cuff tears, tendonitis and shoulder bursitis are some examples of conditions that could lead to impingement. These conditions need to be considered when fixing this condition.
Read on to understand what you should know about shoulder impingement; the risk factors, treatment options and expected recovery time.
What is Shoulder Impingement?
Shoulder impingement is a condition where connective tissue (i.e. tendon) catches over the bony shoulder structures. Most commonly, the tendons from the rotator cuff muscles are involved with the scapula (shoulder blade). Constant rubbing between structures can cause inflammation and shoulder pain.
Shoulder impingement is one of the more common shoulder injuries that can occur. According to the Mayo Clinic, shoulder impingement is defined as “the abnormal compression of the tendons of the rotator cuff and other structures within the shoulder joint, especially when performing movements overhead, like reaching and lifting.”[3]
What are the symptoms of shoulder impingement?
The primary symptoms of shoulder impingement include reduced movement with increased pain when extending above shoulder height. People also experience general stiffness and throbbing pain in the shoulder joint, as well as tenderness around the front of the shoulder.
The most common symptom is known as the “painful arc”. This is when lifting your arm up, it begins to hurt at a certain point in the movement, continues to hurt through an “arc of movement”, but actually gets easier once you get to the top of the motion.
The painful arc usually begins at about 90 degrees, and can let go and get easier once you get past 150 degrees.
Common symptoms of shoulder impingement
What causes shoulder impingement?
Most cases of shoulder impingement are caused by overuse. This can be from activities such as swimming, any throwing sports or an occupation that requires a lot of lifting. Other causes include injuries such as a rotator cuff tear, a torn labrum or arthritic changes.
Common causes of shoulder impingement
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Repeated stress and overuse of the shoulder
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Previous shoulder injuries
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Intense and repetitive overhead activities
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Weakness of the rotator cuff muscles
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Poor shoulder control
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Narrowed joint space
Some jobs such as painting, construction and plumbing may require you to elevate your shoulder for extended periods and can cause shoulder impingement.
Sports that increase the risk of shoulder impingement
Throwing sports and other repeated high-intensity overhead activities can increase the risk of having shoulder impingement.
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Tennis
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Baseball
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Swimming
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Softball
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Cricket
Many factors can lead to shoulder impingement, and sometimes multiple factors may apply to your condition. It is best to have your shoulder assessed as soon as possible to prevent further injury.
How is shoulder impingement diagnosed?
Shoulder impingement can be frustrating and can limit the movement of your shoulder for a very long time. Inability to move your shoulder due to pain can result in further complications if left untreated.
It is essential to have your condition diagnosed early by a medical professional to prevent further damage and start treatment as soon as possible.
There are several options available when it comes to diagnosing your shoulder pain as impingement. One of the more common and most recommended by Australian GPs is an assessment from a physiotherapist.
Physiotherapists are medical experts in the field of joint rehabilitation and pain management. They can diagnose shoulder conditions and effectively provide treatment for your pain and improve the quality of your life.
An assessment from a physiotherapist is comprehensive and straightforward. Your visit will start with a simple consultation. Your physiotherapist will ask vital questions regarding your health and lifestyle. This will help in diagnosing your condition and determining your treatment goals.
After establishing the background of your condition, your physiotherapist will then perform a detailed assessment of your shoulder joint and muscles to determine factors that contribute to your pain and rule out other possible conditions.
Your physiotherapist will then create a diagnosis and treatment plan based on your assessment. This whole process will take about 30 to 60 minutes.
You will also be given the details of your program. This will include:
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Number of treatment sessions
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List of exercises you need to do at home
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Strategies to manage the pain and prevent complications
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Timeline of your recovery.
How is shoulder impingement treated?
Shoulder impingement can be very painful and limit you from doing the activities you loved to do. If you are an athlete, it can prevent you from participating all together.
Immediate treatment of shoulder impingement is advisable to catch it at an early stage.
There are several options when it comes to treating shoulder impingement. One of the more common and the treatment option referred to by Australian GPs the most is physiotherapy.
Shoulder impingement is a condition that physiotherapists come across regularly, and the process of treating it is straightforward.
Following an initial consultation, the physiotherapist will be in the best position to determine your treatment plan.
Your treatment will focus on reducing your pain, treating inflammation and improving your range of motion. Your physiotherapist will also increase your shoulder control and ensure greater strength of your shoulder muscles to prevent re-injury.
Depending on the severity of your shoulder impingement, a physiotherapist may provide you with a combination of the following types of treatments:
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Joint Mobilisation - These are techniques designed to improve mobility around the joint and increase your range of motion. This can also relieve pain and tension in the shoulder joint.
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Therapeutic Exercises - Exercise techniques to correct impairments and improve your shoulder movement.
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Manual Therapy - Hands-on techniques used by your physiotherapist to improve your joint mobility, decrease pain and improve your range of motion.
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Strengthening Exercises - Exercise techniques designed to strengthen your shoulder muscles to prevent injuries and improve control.
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Stretching - Techniques used to increase your range of motion and decrease joint stiffness.
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Taping techniques - Specialised taping techniques to improve shoulder mechanics and promote proprioception or awareness in your body.
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Dry Needling - Specialised treatment used to relieve pain and reduce muscle spasms.
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Advice and Education - Expert advice on how you can manage the pain and gradually return to your activities.
Physiotherapy treatment can last for about 30 to 60 minutes. Most patients can feel the difference in just a single session.
Next step - Creating a treatment plan made for you
After your initial evaluation, your therapist will create a detailed treatment plan based on your condition and goals to maximise your recovery.
Self-care for shoulder impingement
If you have shoulder impingement, here are the best things you can do and avoid.
Things to do:
Shoulder impingement is usually caused by overuse or repetitive stress on your shoulder joint. Take time to rest your shoulders and take a break from strenuous activities for a few weeks. Understand that your body has its natural way of healing.
If you are experiencing pain and swelling of your shoulder joints, apply cold packs for at least 10 to 15 minutes to control the swelling and decrease pain.
Hot packs can also relieve stiffness and allow you to move better. Apply it for at least 15 to 20 minutes on the shoulder area.
Stretching the shoulder muscles can improve range of motion and minimise tension on the shoulder joint, resulting in decreased pain.
Your physiotherapist will teach you proper shoulder stretching techniques that you can incorporate into your daily exercises.
Light massage can help you relax. It can reduce muscle spasms and improve blood circulation in the shoulder area.
Things to avoid:
Avoid engaging in activities that will place a lot of stress on your shoulder joint. Avoid repetitive overhead movements or throwing motions.
Do I need a specialist or surgery?
Severe cases of shoulder impingement may benefit from surgical intervention. This type of surgery is known as subacromial decompression.
It is a procedure that removes parts of the acromion (top of the shoulder blade) to create more space for the rotator cuff tendon. This is only done in long-term shoulder complaints that do not respond to physiotherapy treatment.
Post-surgically, a period of physiotherapy rehabilitation will be required to regain strength and mobility.
What is the recovery time / prognosis for shoulder impingement?
Ultimately, recovery time is dependent on your proactiveness to seek professional treatment and the severity of your shoulder pain and injury.
Recovery for impingement can vary between a few weeks and several months depending on severity.
Physiotherapy can significantly improve the outcome for shoulder impingement and help patients recover faster.
Athletes may gradually return to sports through optimised rehabilitation programs and close coordination with sports physiotherapists.
Important factors in recovery include:
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Sticking to your rehabilitation program and regularly exercising
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Resuming your sports activity gradually
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Paying attention to pain, and resting as necessary.
Can shoulder impingement be prevented?
To guarantee prevention is impossible, however there are some things that can be done to reduce the likelihood. Prevention of shoulder impingement should focus on strengthening and maintaining good range of motion, in order to keep the shoulder in good working condition.
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Strengthen the rotator cuff muscles: Strengthening your rotator cuff muscles can help prevent injuries on the tendon and shoulder joint.
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Pace your training or activity: Have sufficient rest time in between high demanding exercises for your shoulder. Gradually increase your training volume to help your body adapt appropriately to your activities.
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Maintain good posture: A good posture can decrease the risk of shoulder injuries. Keep your back straight, and your shoulder retracted downward and back, especially when working on a computer.
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Practice good throwing mechanics: Proper throwing technique can go a long way in your athletic career and health.
Coordinate with your sports physiotherapist and team coach to give you specific advice on your shoulder mechanics when throwing.
Outlook and the main takeaways
Shoulder impingement can be frustrating and can keep you away from your normal activities. The good thing is most people can make a full recovery through physiotherapy and compliance with treatment programs.
Book a consultation and have your shoulder assessed by a physiotherapist today.
Anatomy of the shoulder
Inside your shoulder, there is a space called the subacromial space beneath the top surface of the upper end of the upper arm (humerus) and the bony tip of the shoulder blade (acromion). This space is bordered by the acromion, coracoid process and coracoacromial ligament.
The subacromial space contains the following structures
Irritation or inflammation of any of these structures can narrow down the subacromial space causing “impingement” of other structures during shoulder movements, particularly during arm elevation.
Problems in the biomechanics of the joint such as inefficient muscle contraction and shoulder control can also cause impingement around the subacromial space.
These cause pain, weakness and difficulty performing movements that require shoulder motions.
