Shoulder Impingement

What is shoulder impingement?

Shoulder impingement is a common affliction, especially among overhead athletes and workers, caused by poor tracking of the head of the humerus bone under the bony roof of the shoulder (acromion). In a normally functioning shoulder, the head of the humerus spins smoothly in the socket avoiding contact with the structures forming the top of the shoulder joint. If the humeral head glides upwards as a person reaches into end-ranges of motion (especially overhead), the humerus may impinge on the acromion, pinching the soft tissues (rotator cuff and bursa) between the bony structures causing pain and limited motion.



How do people get shoulder impingement?

There are two general reasons people experience impingement: primary and secondary. Primary impingement is uncontrollable and related to anatomical factors that adversely affect the interface between the humeral head and the socket. The most common of these are a hooked acromion which means the bone forming the roof of the shoulder joint offers less space than normal, or degenerative changes in the acromioclavicular joint or shoulder joint causing bone spurs to decrease the space between the humeral head and the roof of the joint. Secondary impingement occurs when muscle and capsular imbalances exist and alter the coordination of movements into end-ranges. If the muscles are not working well together, the head of the humerus will not glide underneath the acromion (roof of the shoulder joint) and will impinge, causing pain referral into the upper arm.



How can I avoid shoulder impingement syndrome?


Primary impingement is not a controllable factor and avoidance of impingement symptoms requires staying out of end-ranges that will create impingement. People having these predisposing factors will not do well as swimmers or in throwing sports. Secondary impingement can be avoided by maintaining good posture and muscle balance across the shoulder joint. The maintenance of good posture and the strength of the rotator cuff muscles is particularly essential for people who consistently work or move into the end-ranges of motion overhead. The exercises described below for rehabilitating shoulder impingement syndrome also serve as good exercises for prevention in swimmers and throwing athletes.



How can I deal with shoulder impingement?



If you have shoulder impingement syndrome, the soft tissues that have been pinched consistently are likely rather inflamed and irritated. The initial phase of rehab involves calming the local inflammation with ice, anti-inflammatory medications, rest, postural corrections and pain-free motion. Proper posture puts the shoulder in a neutral position, which increases the space between the humeral head and the acromion and puts the muscles into better positions to work appropriately. Avoidance of reaching into end-ranges overhead is suggested during this time, allowing the tissues to heal. The next phase of rehabilitation builds on the initial postural adjustments adopted during the calm-down phase. The goal during this phase is to progressively regain shoulder motion while avoiding the range of impingement and to rebalance muscle forces across the shoulder.


Please contact Walton Physical Therapy to schedule an injury evaluation and discuss possible treatment options you might need.





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