Shoulder Impingement Treatments, Causes, and Symptoms

Condition • By Biraj Patel

Shoulder impingement, a common orthopedic woe, can wreak havoc on our daily lives. This ailment often presents itself as a nagging pain or discomfort in the shoulder joint, and if left unaddressed, it can evolve into a persistent problem. In this article, we will delve into the world of shoulder impingement, uncovering its symptoms, causes, and the best treatment options.

What is shoulder impingement?

Shoulder impingement, also known as impingement syndrome or rotator cuff impingement, is a condition that occurs when the rotator cuff tendons in the shoulder become irritated and inflamed as they rub against the bony structures of the shoulder. This friction causes pain and discomfort, especially when you raise your arm.

Shoulder impingement symptoms

The symptoms of shoulder impingement can vary depending on the severity of the condition. Some common symptoms include:

Shoulder pain when lifting arm or raising it overhead
Weakness in the shoulder
Limited range of motion in the shoulder
Pain that radiates down the arm
Pain that worsens at night, especially when lying on the affected shoulder

What does an impinged shoulder feel like?

An impinged shoulder can feel like a dull ache or sharp pain in the shoulder joint. The pain may be worse when lifting the arm or raising it overhead. Some people may also experience weakness or limited range of motion in the shoulder.

What causes shoulder impingement?

The causes of shoulder impingement are diverse, but they all revolve around the same problem: the narrowing of the space between the acromion (a bony projection at the top of the shoulder blade) and the rotator cuff tendons. Here are a few common causes.

Overuse: Repetitive overhead motions, such as those used in sports like tennis or baseball, can lead to irritation of the tendons over time.
Anatomy: Sometimes, the shape and structure of your shoulder can naturally predispose you to impingement.
Bone spurs: The presence of bone spurs can further decrease the space within the shoulder joint, aggravating the impingement.

Some factors that may increase the risk of developing shoulder impingement include:

Age: The risk of developing shoulder impingement increases with age.
Occupation: Jobs that require repetitive overhead movements, such as painting or construction work, can increase the risk of developing shoulder impingement.
Sports: Athletes who participate in sports that require repetitive overhead movements, such as baseball or swimming, are at increased risk of developing the condition.
Genetics: Some people may be more prone to developing shoulder impingement due to genetic factors.

Shoulder impingement prevention

To prevent shoulder impingement, especially if you're involved in activities that stress your shoulders, consider these strategies:

Proper technique: Ensure you are using proper techniques when lifting and performing overhead activities.
Posture: Maintain good posture to prevent unnecessary stress on your shoulders.
Strength and flexibility: Regularly engage in exercises that strengthen the rotator cuff and maintain good shoulder flexibility.
Rest: Give your shoulder ample time to recover after strenuous activities.

What are the 4 stages of shoulder impingement?

Shoulder impingement is typically classified into four stages based on the severity of the condition.

Stage 1: Swelling and inflammation of the tendons in the shoulder joint.

Stage 2: Tendons in the shoulder joint become thickened and may begin to fray.

Stage 3: Tendons in the shoulder joint begin to tear, causing significant pain and limited mobility.

Stage 4: The rotator cuff tendon tears completely, requiring surgical intervention.

Diagnosis of shoulder impingement

Shoulder impingement is primarily diagnosed by history and physical examination. Your doctor may also order imaging tests, such as X-rays or an MRI, to help confirm the diagnosis and rule out other conditions.

Shoulder impingement test

The shoulder impingement test is a clinical assessment used by orthopedic specialists and healthcare professionals to diagnose and evaluate the presence of shoulder impingement syndrome. This test helps determine if the symptoms a patient is experiencing, such as shoulder pain and limited range of motion, are indicative of impingement in the shoulder joint. There are several variations of the shoulder impingement test, and one of the most common tests is the Neer test.

Neer test

The patient typically stands or sits with their arm relaxed at their side. The doctor stands behind the patient and stabilizes the patient's scapula (shoulder blade) with one hand to prevent movement. With the other hand, the doctor passively elevates the patient's arm, internally rotating it, so that the patient's thumb points downward and the arm is fully raised.

This action effectively brings the greater tuberosity of the humerus (the upper arm bone) in contact with the undersurface of the acromion (a bony projection of the shoulder blade).

Interpretation

If the patient experiences pain or discomfort during this maneuver, especially in the anterior or lateral aspect of the shoulder, it is considered a positive test for shoulder impingement. This pain is indicative of impingement of the rotator cuff tendons and other structures between the acromion and the humeral head.

Follow-up

A positive Neer Test suggests the possibility of shoulder impingement. The healthcare provider may further evaluate the patient's condition with additional tests, imaging (such as X-rays or MRI), and a comprehensive physical examination to confirm the diagnosis and determine the best course of treatment.

While the Neer Test is a valuable diagnostic tool, it is not the only test used to assess shoulder impingement. Other tests, such as the Hawkins-Kennedy Test and the Empty Can Test, may also be employed to gather more information and provide a more comprehensive assessment of the patient's condition.

These tests are crucial in helping healthcare professionals accurately diagnose and develop an appropriate treatment plan for individuals with shoulder impingement, whether it involves conservative measures, physical therapy, or, in severe cases, surgical intervention. Always consult with a healthcare provider for a proper evaluation and diagnosis if you suspect you have shoulder impingement or are experiencing shoulder pain and discomfort.

Shoulder impingement treatments

The good news is that shoulder impingement can be treated, and treatment largely depends on the severity of the condition. Here's how to approach it.

Conservative treatment

In the early stages (1 and 2), conservative methods such as rest, physical therapy, and anti-inflammatory medications can help relieve symptoms.

Shoulder impingement exercises

Specific shoulder impingement exercises and stretches can strengthen the muscles around the shoulder and improve its stability. Here are some effective ones:

Scapular retraction: Sit or stand with your arms at your sides. Squeeze your shoulder blades together, hold for a few seconds, and release.
External rotation: Attach a resistance band to a doorknob at elbow level. Hold one end with your elbow at a 90-degree angle and pull the band away from the door.
Doorway stretch: Stand in a doorway, placing your forearm on the door frame. Gently lean forward to feel a stretch in your chest and front shoulder.
Cow-face pose: This yoga pose helps stretch the shoulders and may relieve tension.

Remember to consult with a physical therapist or medical professional before starting any exercise regimen to ensure that it is appropriate for your specific condition.

Corticosteroid injections

For those with persistent pain, corticosteroid injections can provide temporary relief by reducing inflammation.

Shoulder impingement surgery

In severe cases (stage 3 or 4) or if conservative treatments fail, surgery may be necessary to remove bone spurs or repair the damaged tendons. It's essential to consult with an orthopedic surgeon to determine if surgery is the right path for you.

Discuss shoulder impingement treatments with the best orthopedic surgeons on PreferredMD

Shoulder impingement can be a debilitating condition, but it is treatable. The road to recovery involves identifying the symptoms, addressing the causes, and considering appropriate treatment options. Whether it's through exercises, conservative treatment, or surgery, the goal is to alleviate pain and restore functionality to your shoulder. Consult with an orthopedic doctor to determine the best course of action for your specific case, and remember, there's hope for a pain-free, active life beyond shoulder impingement.