Impingement syndrome is one of the most common causes of shoulder pain in adults. Impingement syndrome, (also called painful arc syndrome, swimmer’s shoulder, supraspinatus syndrome, and thrower's shoulder) occurs when the tendons of the rotator cuff muscles become irritated and inflamed. Because these tendons pass through the subacromial space (the narrow passage beneath the acromion), the inflammation further narrows this passageway causing an impingement when the arm is lifted. This results in pain, weakness and limited shoulder movement.
* The acromion is the projection of the shoulder blade that forms the point of the shoulder.
* The acromion is the projection of the shoulder blade that forms the point of the shoulder.
Causes
Impingement is common in both young athletes and middle-aged people. Young athletes who use their arms overhead for swimming, baseball, and tennis are particularly vulnerable. Those who do repetitive lifting or overhead activities using the arm, such as paper hanging, construction, or painting are also susceptible.
Other factors can also cause further narrowing of the subacromial space leading to impingement syndrome. These factors include:
Pain may also be due to "bursitis," or inflammation of the bursa overlying the rotator cuff or a "tendonitis" of the cuff itself. In some circumstances, a partial tear of the rotator cuff
Signs and symptoms
The most common symptoms in impingement syndrome are pain, weakness and a loss of movement at the affected shoulder. The pain is often worsened by shoulder overhead movement and may occur at night, especially if the client is lying on the affected shoulder. Other symptoms can include a grinding or popping sensation during movement of the shoulder.
Impingement is common in both young athletes and middle-aged people. Young athletes who use their arms overhead for swimming, baseball, and tennis are particularly vulnerable. Those who do repetitive lifting or overhead activities using the arm, such as paper hanging, construction, or painting are also susceptible.
Other factors can also cause further narrowing of the subacromial space leading to impingement syndrome. These factors include:
- Bony structures such as subacromial spurs (bony projections from the acromion)
- Osteoarthritic spurs on the acromioclavicular joint.
- Variations in the shape of the acromion.
- Thickening or calcification of the coracoacromial ligament can also cause impingement
- Loss of function of the rotator cuff muscles, due to injury or loss of strength, may cause the humerus to move superiorly (upwards), resulting in impingement.
Pain may also be due to "bursitis," or inflammation of the bursa overlying the rotator cuff or a "tendonitis" of the cuff itself. In some circumstances, a partial tear of the rotator cuff
Signs and symptoms
The most common symptoms in impingement syndrome are pain, weakness and a loss of movement at the affected shoulder. The pain is often worsened by shoulder overhead movement and may occur at night, especially if the client is lying on the affected shoulder. Other symptoms can include a grinding or popping sensation during movement of the shoulder.
Exercises to Avoid
These exercises should be avoided until the rotator cuff muscles are strengthened:
These exercises should be avoided until the rotator cuff muscles are strengthened:
- Shoulder Press
- Lateral Raises
- Shrugs
- Upright Rows—the upright rows should be avoided all together even when the rotator cuff muscles have been strengthened.
Shoulder Impingement Treatment
Early treatment for shoulder impingement is paramount for a speedy recovery. A doctor may suggest rest and avoiding overhead activities. Stretching exercises to improve range of motion in a stiff shoulder will also help.
Sample Exercises
Early treatment for shoulder impingement is paramount for a speedy recovery. A doctor may suggest rest and avoiding overhead activities. Stretching exercises to improve range of motion in a stiff shoulder will also help.
Sample Exercises
Chest Stretch
Repeat the stretch three times
- Standing with your side to a wall, place the palm on the wall so that it is in line with your shoulder.
Repeat the stretch three times
Upper Traps Stretch
Increase the stretch by placing one hand on your head for added resistance.
- Sit or stand with a straight back and look straight ahead.
Increase the stretch by placing one hand on your head for added resistance.
- Hold for 30 seconds, then relax and repeat other side
- Repeat the stretch three more times
Levator Stretch
Repeat the stretch three more times
- Standing or sitting with your back straight, lower your chin towards your armpit, and drop the opposite shoulder down towards the floor.
- This will create a stretch from your shoulder to your ear.
Repeat the stretch three more times
Wall Walks Stretch—Sideways
- Stand with your side to the wall and place your hand on the wall.
- Walk up the wall slowly with your fingers until you feel a stretch in your shoulder.
- Hold this stretch for 30 seconds and then release the stretch slowly.
- Repeat the stretch 10 times
Wall Walks Stretch—Forwards
- Stand facing the wall and place your hand on the wall.
- Walk up the wall slowly with your fingers until you feel a stretch in your shoulder.
- Hold this stretch for 30 seconds and then release the stretch slowly.
- Repeat the stretch 10 times.
Wall Ball Writing
- Hold a ball with one hand unto a wall
- Keeping the ball against the wall, write the alphabets for A to Z with the ball.
- Ensure to rest as needed when doing this exercise
PREVENTION
Proper Warm-Up
A thorough and proper warm up helps prepare the muscles and tendons for activity. Without a proper warm up, there is less blood supply to the shoulder muscles resulting in stiff and tight muscles and tendons.
Correct Muscle Imbalances
It is essential that upper body strengthening exercises are balanced. Shoulder impingement is most likely to occur in those with strong front muscles (chest and front of the shoulders) but weak back muscles. Having an equal balance of strength in both front and back muscles is crucial in the prevention and rehabilitation of shoulder impingement injuries.
Avoid Harmful Exercises
It is advisable to avoid movements that decrease or compress the shoulder sub-acromial space the most such as the upright rows. For this reason, the upright rows should be avoided all together even when the rotator cuff muscles have been strengthened.
Adequate Rest
Get plenty of rest as rest is necessary for full recovery of tissues. Limit the painful ranges of motion and allow tissue healing.
Posture
The position of the shoulder blade (scapula) is also an important factor. The correct position for the scapula is back and rotated down. Meaning, the chest is out and the shoulders are pushed back and down. Rounded shoulder (hunched back posture) should be avoided at all times. This posture should be maintained with all activities of daily living and with exercise.
Proper Warm-Up
A thorough and proper warm up helps prepare the muscles and tendons for activity. Without a proper warm up, there is less blood supply to the shoulder muscles resulting in stiff and tight muscles and tendons.
Correct Muscle Imbalances
It is essential that upper body strengthening exercises are balanced. Shoulder impingement is most likely to occur in those with strong front muscles (chest and front of the shoulders) but weak back muscles. Having an equal balance of strength in both front and back muscles is crucial in the prevention and rehabilitation of shoulder impingement injuries.
Avoid Harmful Exercises
It is advisable to avoid movements that decrease or compress the shoulder sub-acromial space the most such as the upright rows. For this reason, the upright rows should be avoided all together even when the rotator cuff muscles have been strengthened.
Adequate Rest
Get plenty of rest as rest is necessary for full recovery of tissues. Limit the painful ranges of motion and allow tissue healing.
Posture
The position of the shoulder blade (scapula) is also an important factor. The correct position for the scapula is back and rotated down. Meaning, the chest is out and the shoulders are pushed back and down. Rounded shoulder (hunched back posture) should be avoided at all times. This posture should be maintained with all activities of daily living and with exercise.
While the recommendations here are a good starting point for shoulder impingement, it is recommended that you see a healthcare professional (such as physician, athletic therapist, massage therapist, etc..) for a complete assessment and treatment recommendations for your injury.
Until next time, stay healthy and keep moving!
P.S.
I welcome any comments or questions you may have, so post them below (click on "comment" button). Help spread our wellness message by sharing, liking or tweeting.
Until next time, stay healthy and keep moving!
P.S.
I welcome any comments or questions you may have, so post them below (click on "comment" button). Help spread our wellness message by sharing, liking or tweeting.
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