Could shoulder impingement be the cause of your shoulder pain? What is shoulder impingement? Is it “bad” to have shoulder impingement? Can Physical Therapy help shoulder impingement? What does shoulder impingement treatment in Rochester look like? Do I need surgery for shoulder impingement? Medication? Shots? Should I just rest it? What is the difference between shoulder bursitis? Or shoulder tendonitis?
That is a lot of questions to answer in one post. Let’s get to it!
Do I have shoulder impingement?
Let’s find out. Here are some common symptoms:
- Pain from the side or front of your shoulder to the side of your upper arm
- Pain with reaching overhead or away from your body
- Pain with reaching across your body or behind your back (reaching your back pocket)
- Pain with sleeping on the painful shoulder – it may wake you up or keep you awake
- Loss of shoulder strength
- Shoulder stiffness
Fun fact: Sometimes there can be pain when you raise your arm between 60 and 120 degrees or so. The pain then decreases or disappears when you raise your arm further. This is known as a “painful arc.”
Initially, you may notice these symptoms with certain movements and in certain positions. When your shoulder gets more irritated the pain can become constant and quite severe. Typically our shoulder impingement clients have had some off and on problems for a while, then they “do something” and the you-know-what hits the fan. They did some painting, some gardening, reached in that cupboard, played some catch, slept wrong and pain is suddenly much worse and more constant.
Fortunately, we can help the majority of them feel much better than they did before the flare-up. And they leave wishing they had it taken care of before the big flare-up!
What is shoulder impingement?
This is going to take a little anatomy lesson. There are three bones that play a role here: the upper arm, the shoulder blade, and the collar bone. The end of the shoulder blade (called the acromion) and the collar bone together form the “roof” of the shoulder. The upper arm sits below the roof with some room in between for tendons of the rotator cuff and a bursa (you may know it from bursitis – when the bursa is inflamed). “Impingement” happens when there isn’t enough room for the tendons or bursa between the upper arm and roof of the shoulder… They get “pinched” and over time that causes irritation and inflammation which, of course, is painful. If this continues, lasting damage to the rotator cuff can occur and lead to the dreaded rotator cuff tear.
So to answer the question of impingement is bad… It depends. It is often very treatable without surgery or injections. If treated early you can regain a very functional happy shoulder. When ignored it can unnecessarily hold you back from doing things you love or worse, lead to tendon damage that is much more difficult to treat and limits your ability to do all the fun and necessary stuff even more.
Why does shoulder impingement happen? 4 mechanisms
The bottom line is that soft tissue (tendon, bursa) gets pinched between two bony surfaces. This can happen for a few reasons:
- Soft tissue is swollen (due to overuse for example). Now it is easier to get pinched within the space available. In our experience, it is very rare that this happens without reasons 2 and/or 3 being present also.
- Bone spurs or thickening of the ligaments at the joint between the collar bone and the shoulder blade
- A differently shaped acromion (end of the shoulder blade) decreases the available space. You have had this shape your entire life. So it was possible to function without a problem at one point.
- The mechanics of the shoulder joint are off because of capsule tightness or a muscle imbalance (some muscles are too strong compared to others). This causes extra narrowing of the available space when you raise your arm.
What does shoulder impingement treatment look like?
The good news is, the majority of patients with shoulder impingement, regardless of which mechanism of impingement you have, do really well with conservative treatment (meaning, no surgery, no injections). Conservative treatment is the recommended starting point. It should become obvious quickly if additional help is needed. We work with some great doctors in the area that can assist you when needed.
Effective treatment starts with a thorough assessment of your shoulder to determine what is your main cause of the problem. Then treatment will be a combination of pain-relieving activities (hands-on muscle and joint work, rest/ice), specific strengthening exercises, and flexibility exercises.
Your Physical Therapist is a great place to start getting rid of your shoulder pain. The Physical Therapists at WV Physical Therapy have had great success in helping many shoulder patients get back to normal.
If you would like us to help you get your shoulder back on track click here to request an appointment now