Shoulder impingement

Have you heard this term before and wondered what exactly it is that your shoulder is pinching? The more important question is to ask is why it is it getting pinched. Shoulder impingement is when the muscles in you shoulder get trapped between bony parts of the joint which leads to pain and inflammation. This can be caused by a large variety of things and can be tricky to pinpoint sometimes. Many people experience regular shoulder pain when doing certain activities but start getting worried when it worsens or becomes more consistent. Identifying the problem early on is key to starting the rehabilitation process. Here are a few points on recognising the symptoms, home management tips and a few basic exercises to correct the most common causes of shoulder impingement.

It’s important to note that shoulder impingement is not a diagnosis but a clinical sign that tells you something else is wrong. There has been a strong suggestion from the health care community to scrap the term all together as it is not very informative and therefore can be very misleading when given as a diagnosis. Firstly, some anatomy:

Your upper arm, shoulder blade and collar bone all come together to form a small tunnel through which your supraspinatus muscle travels from your shoulder blade to the front of your upper arm. This muscle mainly helps to lift the arm up. Sometimes the tunnel can get narrower which places pressure on the tendon of the muscle passing through, leading to pain and inflammation. Initially the pain will only be with certain overhead activities, but it can become more persistent as the inflammation builds up, later even waking you up while you’re sleeping. The narrowing of the tunnel can be due to primary or secondary reasons meaning that the problem can be due to issues inside the joint itself, such as a bony spur that has grown in the tunnel, or due to outside factors closing the tunnel. Below are a few of the most common secondary causes of shoulder impingement.

Causes: – many of these go hand in hand with one another

  • Weak shoulder blade stability – your lower trapezius and serratus posterior muscles should act to prevent the shoulder blade from lifting too high during shoulder movements. When they are weak, the shoulder blade rides up and closes that tunnel down.
  • Tight upper trapezius – due to stress, poor posture, inadequate stretching etc. This muscle pulls the shoulder blade up.
  • Tight pectorals – when your pecs are tight, they pull your shoulders forward into a rounded posture, again closing that tunnel down.
  • Thoracic kyphosis or scoliosis – big words to describe a curved spine. Your shoulder blades need to glide over your upper back, if the spine is too curved it will prevent your shoulder blades from gliding down.
  • Overuse – repeated overhead activities such as swimming, throwing and even computer work when sitting with poor posture
  • Direct trauma – such as lifting something too heavy or falling on an outstretched arm.

Symptoms

Typically, pain is felt at the top of your shoulder and into your upper arm, sometimes even to the elbow. Overhead activities such as reaching for the top shelf, swimming, shoulder presses etc where your arm is next to your ear are the worst. It may be painful to sleep on that shoulder or put on a coat/jacket and the arm may feel weak. Over an extended period, degeneration of the tissue starts to occur in the tendon which can lead to gradual tearing. Other structures such as the bursa and the biceps tendon may get involved too, leading to a more complicate rehab process.

So, what can you do? Prevention is key. Take care when doing exercises in the gym, always ensure that your shoulders are level and not scrunched up to your ears where the tunnel will be narrowed, and the tendons compromised. Try sit with good posture at work with your elbows level to the desk and the mouse as close to your midline as possible. Rest appropriately between training sessions and allocate time to stretch.

Treatment usually consists of rest form any aggravating activities. In the initial phase, anti-inflammatories may help but is unlikely to make any difference later. Overhead activities need to be avoided as well as carrying heavy objects with that arm. Rehabilitation will be determined by the cause of the impingement since every exercise program should be individually tailored to the person’s problem therefore it’s vital to get to the root of the problem first before starting any treatment. If conservative treatment is unsuccessful, cortisone injections or arthroscopies to repair the tendon or widen the tunnel are further options. Basic posture exercises can help with the less severe cases. Here are a few stretches and exercises to help set the shoulder blade and keep it there.

1.      Pecs stretch and upper back

Clasp your hands behind your head keeping your elbows in line with your ears. Open your chest up to the ceiling to feel a stretch through your shoulder blades and front of chest.

Hold for 10 seconds.

2.      Side neck stretch

Turn your head to the right and slowly look down to your right shoulder whilst holding on to the chair seat with your left hand until you feel a gentle stretch through the left side of your neck.

Hold 10 seconds and repeat both sides.

3.      Scapular setting

(Picture credit Physiotec)

On your stomach with your hands next to your sides, palms facing down, and chin gently tucked in. Open your shoulder by imagining you are putting your shoulder blades into your back pockets. Lift your hands up and reach them towards your feet. You should feel the muscles between the shoulder blades working hard.

Hold for 10 seconds and repeat 10 times