What Is Shoulder Impingement & How is it Caused?
Shoulder Impingement is a painful condition of the shoulder characterized by severe pain with any attempts at moving the shoulder in any direction. The main reason behind the development of Shoulder Impingement is inflammation of the tendons around the shoulder. This inflammation of the tendons usually occurs as a result of overuse or an injury to the shoulder. This condition is medically referred to as Rotator Cuff Tendonitis.
Shoulder Impingement can also be caused as a result of inflammation of the bursa, which is a fluid filled sac, around the subacromial region of the shoulder resulting in a condition called as subacromial bursitis.
Other than overuse and injury due to the trauma, repetitive stress injuries like lifting heavy items above the head repetitively results in the tendons to become entrapped causing Shoulder Impingement.
Sportsmen involved in tennis, golf, swimming, and weightlifting are more at risk for developing Shoulder Impingement. Additionally, individuals involved in construction industry where they have to repetitively lift heavy objects above the head are also prone to developing Shoulder Impingement.
What Are The Symptoms of Shoulder Impingement?
Some Of The Symptoms Of Shoulder Impingement Are:
- Severe pain in the shoulders with movement, especially overhead is the primary symptoms of shoulder impingement.
- Radiation of pain down the elbow.
- Shoulder pain when lying down on the affected side which may advance to even rest pain as the condition progresses.
- Muscle weakness when trying to lift items can also be asymptom of shoulder impingement.
- Pain with reaching for objects kept at the top of the shelf like cutlery in the kitchen.
- Pain with reaching for a seat belt when about to drive.
What Are The Treatment Options For Shoulder Impingement?
Shoulder Impingement is quite a complex injury as there are many structures that are at play here. The pertinent question that decides the form of treatment is the cause of the injury. This is especially important if the pain was of gradual onset and started worsening with each passing day. If there is an injury to the rotator cuff, then it is extremely important to identify which part of the rotator cuff is injured as the treatment varies significantly for different parts of the rotator cuff muscles. There are basically five stages of recovery from which have been delineated in detail below.
Stage I: This stage of treatment involves relieving of pain and decreasing swelling caused due to Shoulder Impingement. For the pain and inflammation to calm down and for reducing swelling, the patient will be requested to completely rest the shoulder and avoid any aggravating activities.
The affected shoulder may also be put in a sling for immobilization to give time for the tendons to heal and the inflammation to calm down. The patient will also be advised to ice the affected area for 15 to 20 minutes two to three times a day by either wrapping ice cubes in a towel or by using icepacks. This will need to be done until the pain symptoms and the swelling completely resolves.
This will be followed by compression of the affected area. For this, a compression wrap is good enough to support the injured soft tissues structures and calm down the inflammation. The patient will also be given NSAIDs in the form of ibuprofen and Motrin for pain relief from shoulder impingement.
Stage II: In this stage of treatment for Shoulder Impingement, the patient is sent to the physical therapist for restoration of shoulder range of motion. Depending on the level of injury, the physical therapist will formulate a detailed exercise regimen best suited for the patient.
Stage III: This treatment stage of shoulder impingement involves restoration of strength of the shoulder so that the patient can move the shoulder in any direction without any discomfort. This will require aggressive strengthening exercises which will be designed by the physical therapist.
Unless and until full strength and function of the shoulder is back, it would not be possible for the patient to move the shoulder at any level without causing significant discomfort and pain.
Stage IV: Once strengthening exercises are started, the patient will be gradually asked to move the shoulder forwards and backwards and then sideways. Once the patient is able to do it without any discomfort then the patient will asked to lift the arm up above the head. If the patient is able to do it without any discomfort then the patient will be asked to do these exercises on a daily basis until full strength of the arm returns.
Once the patient is able to move the arm normally in any direction and is able to lift the arm then the physical therapist will formulate a return to sports exercises. This will include working on speed, agility, and power. The physical therapist will focus on proprioception exercises to build strength in the arm to allow the patient to return back to sports in the earliest possible time.
Stage V: This stage of shoulder impingement treatment involves returning the patient back to normal activities including sports. This is usually done once the patient is able to do all agility, power, and exercises involving speed and can carry out activities like gentle throwing and lifting without any discomfort.
Once the patient has been deemed as cured from Shoulder Impingement by the physical therapist, the trainer may ask the patient to do certain sport specific exercises upon completion of which the patient will be gradually drafted back into competitive sport.
Steroid Injections: Apart from the above mentioned treatments, steroid injections in some cases may also be helpful in treatment of Shoulder Impingement, especially if they are done in the earlier stages of injury.
They work by calming down the inflammation and reducing pain and swelling. However, this treatment is not always given as steroid injections may not always be beneficial and has its own risks and complications.
- American Academy of Orthopaedic Surgeons. (2021). Shoulder Impingement/Rotator Cuff Tendinitis. OrthoInfo https://orthoinfo.aaos.org/en/diseases–conditions/shoulder-impingementrotator-cuff-tendinitis
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