The space between the top of the shoulder (the acromion) and rotator cuff tendon is known as the subacromial space. If pain occurs when the humerus is rotated inward it is known as shoulder impingement syndrome. When the arm moves to certain positions, the tendon and the bursa are pinched and trapped between the top of the acromion bone and the humerus bone. Shoulder impingement syndrome can cause micro tearing of the rotator cuff and gradual degeneration. Over time, impingement syndrome can progress to a full tear of the rotator cuff.
As a result, the tendons of the rotator cuff become inflamed. This condition can be caused by a number of things, including:
- Repetitive overhead use of the shoulder
- An injury during a motor vehicle accident
- Playing sports that involve excessive overhead use of the shoulder, including swimming, weightlifting, tennis and baseball
Shoulder impingement is also known as swimmer’s shoulder, tennis shoulder and rotator cuff tendinitis.
Shoulder Impingement Symptoms
The symptoms of shoulder impingement syndrome include one or several of the following:
- Minor pain, which presents itself with both activity and rest
- Pain that radiates from the front of the shoulder to the side of the arm
- Sudden piercing pain with lifting and reaching movements
- Pain while throwing an object
As shoulder impingement syndrome progresses, the symptoms tend to increase, and include:
- Pain while sleeping
- Loss of strength and limited mobility
- Difficulty participating in activities that require the arm to be placed above the head or behind the back, such as combing the hair or putting on a jacket or shirt
Causes and Risk Factors
The causes of shoulder impingement syndrome vary, and can include:
- Repeated stress to the shoulder, which is caused by activities that involve throwing or raising the arm
- Most commonly occurs in young athletes and the middle-aged. Athletes who participate in swimming, baseball, tennis, and weightlifting, and construction workers whose jobs involve repetitive lifting or constantly raising the arms above the head
- Anatomical factors can also place a person at greater risk of developing this condition, such as the shape of the acromion or the degenerative changes that some people experience. Poor posture and weak or imbalanced shoulder musculature can also lead to impingement syndrome.
Diagnosis and Stages
Initially, your doctor takes your full medical history and performs a physical examination. During the physical examination, you will be asked to:
- Move your arm above your head and behind your back, on your own.
- Relax your arm while your doctor moves your arm above your head and behind your back.
X-rays are routinely obtained and MRI scans are sometimes useful in diagnosing shoulder impingement syndrome, as these scans allow your doctor to rule out arthritis or rotator cuff tears as a cause of the pain and limited motion.
Treatment Options and Procedures
Non-surgical and surgical treatments can be used for impingement. The vast majority if shoulder impingement can be treated nonoperatively with PT to correct imbalances of the muscles around the shoulder, and occasionally steroid injections.
Non-surgical options include:
- Non-steroidal anti-inflammatory medicines
- Physical therapy
- Steroid injection
Surgery may be recommended when non-surgical methods aren’t effective. Arthroscopic surgery performed by an orthopaedic surgeon is minimally invasive and re-creates space for the rotator cuff to move smoothly. Inflamed bursa that surround the rotator cuff tendon are also removed.
Generally, physical therapy is recommended during recovery from impingement surgery. After surgery, your arm may be placed in a sling to limit movement and provide support for a few days. A rehabilitation program will be recommended by your doctor, and will address your specific needs, and includes exercises that improve the range of motion and strengthen the arm. It usually takes between 6-12 weeks to completely heal.
Frequently Asked Questions
Why does shoulder impingement hurt more at night?
Why shoulder impingement hurts more at night isn't completely understood. Inflammation could be part of the reason, which can occur when you hold your joint in one position for an extended period of time. When you hold your arm close to your body, you can restrict blood flow to your bursa and rotator cuff tendon.
Pain is sometimes associated with this position. When you're experiencing pain during the night, especially if you're a professional or high school athlete, it’s a definite red flag something's wrong, and you need to seek your doctor for expert care. However, even non-athletes can have shoulder impingements and experience pain.
Can shoulder impingement cause headaches?
Absolutely. Headaches could occur with shoulder and neck pain simultaneously. In fact, studies have shown that tension-type headaches often go along with increased tenderness in the shoulder and neck muscles.
When you have tender spots in your body's connective tissue or muscles, it's called "trigger points" and when touched, are painful. These trigger points may feel like knots, nodules or tight muscles.
Patients often describe the pain in tension-type headaches as a feeling of pressure in or around their head or like a band is tightening around their head. Research estimates up to 80 percent of adults have tension-type headaches. If you're experiencing these headaches with your shoulder impingement, Dr. O'Grady and his staff can help alleviate the pain they cause.
Where should I ice my shoulder impingement?
When you get any new muscle injury, your first step is to reduce the swelling, inflammation and pain associated with it. You may be tempted to use heat on your sore shoulder, but during the first seven days after you are injured, you'll want to use ice only. Ice helps reduce your inflammation, swelling and pain. Apply the ice to your skin for around 15 minutes; if needed, wrap the ice bag in a towel to avoid irritating the skin.
Will steroids or acupuncture help shoulder impingement?
Yes. While your orthopaedic surgeon at O’Grady Orthopaedics treats most shoulder impingements with physical therapy, they do use steroid injections occasionally. Acupuncture may also help to manage pain and reduce inflammation if you have an acute shoulder impingement.
Can you tape a shoulder impingement?
Yes. Taping helps align your shoulder back to its normal position and provide space for your injured structures to heal.