SHOULDER IMPINGEMENT – CAUSES AND TREATMENT
What is shoulder impingement?
Shoulder impingement is a common cause of shoulder pain. It’s also known as impingement syndrome or swimmer’s shoulder, since it’s common in swimmers. It’s also common in other athletes who use their shoulders a lot, such as baseball or softball players.
Your rotator cuff is a group of muscles and tendons that attach your upper arm bone to your shoulder. They help you lift and rotate your arm. The rotator cuff sits under the top of the shoulder, which is called the acromion. If you have shoulder impingement, your rotator cuff catches or rubs against the acromion. When you lift your arm, the space (bursa) between the rotator cuff and acromion narrows, which increases pressure. The increased pressure irritates the rotator cuff, leading to impingement.
What are the symptoms?
The main symptom of shoulder impingement is sudden pain in your shoulder when you lift your arm overhead or backward. Other symptoms include:
- minor but constant pain in your arm
- pain that goes from the front of your shoulder to the side of your arm
- pain that gets worse at night
- shoulder or arm weakness
What causes it?
Many cases of shoulder impingement are caused by overuse. Repeated use of the shoulder can make the tendons in your shoulder swell, leading them to “catch” on your upper shoulder bone. In other cases, there’s no known cause.
Who’s at risk of having it?
Playing sports that require using your shoulders for overhead or forceful motion is the biggest risk factor for developing shoulder impingement. Common activities that could cause this include:
Occupations that require lots of heavy lifting or arm movement also increase your risk. These include:
- construction work
- moving boxes
Both old age and previous shoulder injuries, such as a dislocation, are also risk factors for shoulder impingement. Some people also have an unusually shaped acromion that increases their risk.
How is it diagnosed?
Your doctor may start by asking you some questions about any previous injuries as well as your exercise habits. Next, they may ask you to do a series of motions using your shoulder while they check for any unusual movement. This will also help your doctor rule out other conditions, such as a pinched nerve.
In some cases, you may also need an X-ray to rule out arthritis or check for bone changes, such as a spur, that could lead to impingement.
If your doctor thinks that you have a more serious rotator cuff injury or they still can’t diagnose you, they might use an MRI scan to get a better look at your shoulder.
There are many types of treatment available for shoulder impingement, depending on how severe your case is.
Home care for Shoulder Impingement
Rest is very important when it comes to treating shoulder impingement. Avoid strenuous exercise or any movements that make the pain worse. This is especially important if you’re an athlete
While it’s best to not move your shoulder too much, avoid using a sling to immobilize your arm completely. This can lead to more weakness and stiffness in your shoulder.
Try placing an ice pack on your shoulder for 10 to 15 minutes at a time, a few times a day, to reduce pain and any swelling you might have.
Shoulder impingement usually responds well to physical therapy, which uses gentle exercises to rebuild strength and range of motion. Your doctor can refer you to a physical therapist who specializes in shoulder injuries.
Your physical therapy sessions will likely focus on the muscles in your shoulder, arm, and chest, which can help to improve the function of your rotator cuff. If you’re an athlete or work in a field that requires frequent use of your shoulder, your physical therapist can teach you proper techniques to reduce your chance of recurrence.
They may also give you some exercises that you can do at home, which may help you recover faster. Just make sure you don’t overdo it.
Taking nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin), can help reduce swelling and shoulder pain. If these medications, along with ice and rest, don’t reduce your pain, your doctor might prescribe steroid injections to reduce swelling and pain.
If other treatments don’t seem to work, you may need surgery to widen the space around your rotator cuff. This allows it to move freely without catching or rubbing on your bone. This can usually be done with minimally invasive arthroscopic surgery, though more severe cases may need traditional open surgery. A recent study has questioned the benefit of removing the bone just for impingement.
In rare, advanced cases of shoulder impingement, your rotator cuff can tear. If this happens, you’ll likely need surgery to repair the tear.
Following any type of shoulder surgery, you may need to briefly wear an arm sling. Your orthopedic surgeon will determine when you can remove the sling.
Shoulder impingement usually takes about three to six months to heal completely. More severe cases can take up to a year to heal. However, you can usually start returning to your normal activities within two to four weeks. Just make sure you regularly check in with your doctor to make sure you aren’t overdoing it. This can increase your recovery time or lead to other injuries.
During your recovery from shoulder impingement, you should avoid any activities that involve throwing, especially with your arms overheard, such as tennis, baseball, and softball. You should also avoid certain types of weightlifting, such as overhead presses or pull downs. If you’re a swimmer, you should take some time off from training to allow the recovery process to progress.
While it’s important to rest your shoulder, you can do some light exercising to strengthen your rotator cuff and stretch the muscles in your arm, shoulder, and chest.
Try these exercises:
- Stand with your arms at your sides and your palms facing forward. Squeeze your shoulder blades together and hold for five to ten seconds. Repeat a few times.
- Stretch your arm straight in front of you and move it forward using only your shoulder. Then move your shoulder as far back as you can without moving your neck or back, or bending your arm.
- Lie on your unaffected side and bend your top arm in a 90-degree angle. Keep your elbow on your hip and rotate your lower arm up toward the ceiling. Repeat 10 to 20 times.
- Stand in a doorway, holding the side of the frame with your arm slightly below shoulder height. Turn your upper body away from that arm until you feel a slight stretch, and hold.
If any of these exercises cause pain, stop doing them or try holding them for a shorter period of time.
Living with shoulder impingement
While shoulder impingement can be painful and affect your daily activities, most people make a full recovery within a few months. In many cases, you’ll just need some rest and physical therapy. If those don’t provide relief, you may need surgery, which can add a few months to your recovery time.
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