What is shoulder impingement?

Elephant Park clinic

As the word itself suggests an impingement refers to the excessive rubbing or catching of two nearby structures. In the case of shoulder impingement this happens between tendons and bursae (anatomical pads used to absorb the friction while moving) and the bone itself, as you lift your arm.

It usually affects the rotator cuff tendons, which connect the muscles around your shoulder joint to the top of your arm.

Shoulder impingement is a very common cause of shoulder pain and can also be referred to as sub acromial impingement as it most commonly happens between the acromioclavicular joint and the underneath head of the humerus, causing the compression of the subacromial/subdeltoid bursa and of the supraspinatus tendon (part of the rotator cuff).

Even though an impinging shoulder can improve on its own in a few weeks or months, especially with the right type of shoulder exercises, occasionally it can be an ongoing problem and cause long term reduction in range of motion as well as chronic pain.

Symptoms of shoulder impingement

Shoulder impingement can develop suddenly as a result of sport injuries such as heavy weight lifting or powerful throwing exercises as well as more gradually, in which case it will be a result of small microtraumas occurring over time and brought on by poor postural habits or repetitive strain injuries.

Symptoms may include:

  • Acute pain in the top and outer side of your shoulder (where the acromioclavicular joint and bursa are)
  • Pain at movement (painful arch), especially above 90 degrees.
  • Ache at night and feeling of restlessness in your arm, making it difficult to find a comfortable position in bed.
  • Reduced power and strength in your arm.
  • Possibly reduced range of motion due to pain.

What should I do?

Go see a physiotherapist or an osteopath.

These practitioners specialise in assessing and treating musculoskeletal conditions such as shoulder impingement. They’ll ask you to perform certain movements and will carry out some clinical testing in order to reach a diagnosis and advise on whether you are likely to be suffering from shoulder impingement or not.

Some physiotherapists and osteopaths are also trained as sonographers and will be able to scan your shoulder with an ultrasound machine (same as the one used in pregnancy) to aid the diagnosis and quantify the level of catching happening within your joint.

Based on the diagnosis they will propose a treatment plan for you which may combine manual treatments such as:

  • Manipulation of joints
  • Soft tissue and myofascial release
  • Ultrasound therapy
  • Dry needling
  • Taping

And exercise prescription for the rehabilitation of the muscles and tendons of your painful shoulder. These exercises might include:

  • Self mobilisation and range of motion exercises
  • Strengthening exercises with an elastic band or small weights (link to a video resource)
  • Stabilisation exercises such as plank
  • Postural advice.

Your practitioner will also be able to discuss with you a likely prognosis and recommend you to come back for a number of sessions. This number may vary from 2/3 in less severe cases up to 10/12 in most severe cases.

Research shows that conservative treatments such physiotherapy and osteopathy are the gold standard for the management of shoulder impingement. However, in cases where this isn’t successful enough your practitioner or doctor might recommend you to consider a steroid injection to alleviate further the inflammation on the joint soft tissues.

Shoulder impingement