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The shoulder is vulnerable to a many differing problems due to its complex nature - combining several joints, tendons and muscles which allow for a broad range of movement. The shoulder is inherently unstable and its function can be likened to a seal trying to balance a ball on it's nose! It is very reliant of good muscle strength and function for support and stability and when this is not present, one of the common painful conditions which may develop is shoulder impingement also referred to as rotator cuff tendinopathy or impingement syndrome.
Treatments include Physiotherapy (usually the first approach) which may involve exercise, manual therapy and medical acupuncture/dry needling, as well as other procedures such as local injections and surgery in certain cases.
Impingement relates to a narrowing of the space between the acromion (a bony prominence at the tip of the shoulder blade) and the head of the humerus (top end of the arm bone) moving too close to one another resulting in compression and irritation of the rotator cuff tendons which pass between. This may occur for a variety of reasons, one of the more common being poor muscle function resulting in instability. When this occurs the head of the humerus moves about excessively in the shoulder socket and is more likely to ride upwards and catch the tendons beneath the acromion.
When the rotator cuff tendons become compressed and irritated, this may over time result in a 'breaking down' of the tendons referred to as as 'tendinopathy'. Ideally the problem would be treated early and settled before the more advanced stages of tendinopathy develop.
Pain-free movement of the shoulder joint is assisted by lubricating sac's called a bursae which reduce friction or act as buffers between moving parts. These bursae can also sometimes swell and become inflamed resulting in pain. One of the more common to become inflamed sits near the rotator cuff tendons and should be differentiated as a separate or associated problem.
Causes of shoulder impingement pain
Pain from the rotator cuff tendons and associated structures can occur for a number of reasons and sometimes with no apparent cause. Sports enthusiasts who engage in throwing activities or any sport which requires repetitive use of the shoulder are at risk, especially if the lack adequate strength and stability in elevated arm positions. Sports such as tennis, swimming or basketball are some examples.
Minor injuries as a result of sudden impact can also be a cause of developing rotator cuff pain.
Symptoms of shoulder impingement
You will typically experience pain when you lift your arm above shoulder height (often with a catch of pain mid way) but in some cases pain will be felt even when the arm is used at lower levels. There may be sensations of aching pain radiating down the arm from the outer part of the the shoulder. It is common for the neck and upper back to become stiff and painful as well. Everyday tasks and sports may be limited by pain.
Quite often such pain from the rotator cuff can be mild and does not necessarily cause a stop in sport immediately. This results in some athletes pushing through the pain rather than resting which can go on to cause more severe symptoms.
When pain continues at rest and or when normal movement is restricted it is advised to seek a professional medical assessment and treatment, such as from a Chartered Physiotherapist.
How to treat shoulder impingement
The first response to pain and dysfunction should be rest from aggravating activities. Anti-inflammatory medicines may be taken to help reduce swelling and pain in the early stages.
If the pain has not settled and movement is still restricted after 3-4 days it is recommended to consult a Chartered Physiotherapist who will carry out an assessment to determine the cause of the impingement and then focus on further reducing pain, restoring movement, strength and function as required.
If necessary, local injections can be used to help assist the treatment process. If needed surgical treatment options exist which can create more space for the rotator cuff however conservative treatment such as physiotherapy should always be tried first.
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by Simon.
