Shoulder Impingement - Overview

Shoulder pain is one of the most common physical complaints, and for good reason. The shoulder has the greatest range of motion of any joint, and the sheer number of structures in the shoulder leaves room for malfunctions. Shoulder impingement (a.k.a. swimmer's shoulder) is one of the most common causes of pain in the shoulder, but it’s easy to treat if caught early. In this article, we’ll dive into the shoulder impingement causes, symptoms, and treatment options.

What is Shoulder Impingement?

Two regions in the shoulder girdle complex sit very close to each other: the acromion (articulating with the end of the collar bone) and the coracoid (a bony process on the shoulder blade itself). These bony processes form a protective arch, or subacromial space, around the rotator cuff tendons together with surrounding ligaments and bursae (the body’s built in cushioning for limiting friction with shoulder use between the bones, tendons and ligaments). Shoulder impingement happens when these protective bones or ligaments in the shoulder pinch—or “impinge”— one or more of the sensitive rotator cuff tendons, causing pain with movement and inflammation.

Types of Shoulder Impingement

It’s important to pinpoint your shoulder pain to make it easier to diagnose. Shoulder impingement syndrome manifests in different forms:

• Internal shoulder impingement

  Is characterized by pain in the back of the shoulder, typically caused by excessive external rotation, like throwing a baseball.

• Primary shoulder impingement

  Is a structural issue in the shoulder, characterized by narrowing of the subacromial space that causes friction and inflammation.

• Secondary shoulder impingement

  Is often caused by poor kinematics and lifestyle factors, such as hunching, weak back muscles, rotator cuff weakness, or poor exercise technique.

• Anterior shoulder impingement

  Happens when the head of your arm bone (humerus) is pulled anteriorly (to the front of your body) by overdeveloped pectoral, anterior deltoid, and bicep muscles. Again, this causes pinching and friction of the rotator cuff.

Common Causes

Shoulder impingement is rarely triggered by one specific event. Rather, it is caused by a series of events like repetitive movements or lifestyle factors like slouching. Some people’s shoulder structure predispose them to shoulder impingement syndrome.

• Repetitive Activities

  Those involved in activities like baseball, swimming, tennis, or golfing are more prone to developing shoulder impingement pain. You may also be susceptible if you regularly perform repetitive overhead movements like lifting, painting, or construction.

• Structural Abnormalities

  Shoulder impingement syndrome can also be caused by structural abnormalities. These include osteophytes (excess bone formation), congenital bone alignment, and ossification of local ligaments and tendons. Structural abnormalities can create a smaller space for the rotator cuff tendon to rest, which puts extra pressure on the tendon.

Symptoms of Impingement

The symptoms of an impinged shoulder are fairly easy to recognize. If any of the following sound familiar, consult your doctor to determine whether an impinged shoulder is the cause.

• Restriction and/or pain when your arm is at shoulder level or overhead
• Pain when reaching behind your back or head
• Weakness of shoulder muscles
• Pain or weakness when lifting objects
• Pain when lying on the affected shoulder
• Persistent shoulder pain, stiffness, and swelling

Diagnosis

Giving your doctor specific examples of your symptoms helps them properly diagnose your pain. Here are a few methods your doctor will use to render a diagnosis.

• Physical Tests

  Your doctor will ask you about symptoms, job duties, and hobbies and will assess your muscle strength and posture. Simple shoulder impingement tests involve moving the shoulder into different positions. The most common tests are the Neer Test and the Hawkins Test. If you have shoulder impingement, you’ll most likely experience pain when these tests are done properly.

• Imaging Techniques

  If the physical tests do not deliver definitive results, your doctor may order an X-ray or MRI. X-rays don’t always reveal the extent of shoulder impingement but may be used to identify bony alignment and growth. Thus, MRIs are used more often. They do not use any radiation and give clear pictures of shoulder abnormalities.

Recovering from Shoulder Impingement

Shoulder impingement recovery time varies depending on severity and the individual. An experienced physical therapist can address shoulder impingement recovery in stages, which takes two to six months—or longer for athletes. Of course, surgical procedures require longer recovery time.

For comfort during the recovery process (and maybe even after), you might consider wearing a shoulder brace for comfort.

Shoulder Impingement Physical Therapy

Treatment & Prevention

Prevention is always the best route, especially if your genetics or activities predispose you to shoulder impingement syndrome. Olympic weightlifters, tennis players, swimmers, or other athletes should include rotator cuff exercises in their normal weekly fitness routines to prevent injury.

Shoulder Impingement Exercises

Stretches for Shoulder Impingement

Remember to maintain good posture—sit up straight and use proper body mechanics during sports and daily activities (even sleeping!). If you need help with your posture, a physical therapist may use k-tape for proper training too.

Kinesiology Tape for Shoulder Impingement

Treating Shoulder Impingement

Best Sleeping Positions for Shoulder Impingement

Lastly, when dealing with pain and inflammation don’t forget about the benefits of using tools that increase blood flow to promote healing. Treatment options include the use of ice, heat, massage, and a TENS unit.

Massage for Shoulder Impingement

The bottom line is to treat your shoulders well and they will reward you with years of pain-free use.