impingement syndromeChronic shoulder pain can be due to shoulder impingement syndrome. Shoulder impingement has primary (structural) and secondary (posture & movement related) causes that lead to fraying and eventually, tearing of the rotator cuff tendons. The tendons of the rotator cuff pass intimately underneath a bony area on their way to attaching to the top part of the arm bone. When these tendons become inflamed in the bony area, they can become frayed during shoulder movements. Impingement can occur due to structural issues, such as arthritis, or it can be due to instability in the shoulder. This means that there is a combination of too much movement, ligament laxity and/or muscular weakness around the shoulder joint. This condition can also occur in persons who were born with a hooked collarbone. Impingement usually occurs over time due to repetitive overhead activity, trauma, previous injury, poor posture or inactivity.

In the early stages, pain is mild with impingement and occurs during overhead activities and when lifting your arm to the side. Pain is more likely in the front of the shoulder and may travel to the side of the arm. The pain usually stops before the elbow. If the pain goes down the arm to the elbow and hand, this may indicate a pinched nerve. Over time, pain may be present while resting; such as when lying on the affected shoulder. You may have weakness and a loss of motion when raising the arm above your head. Your shoulder can feel stiff with lifting or movement and it may become more difficult to place your arm behind your back.

Diagnosis of impingement syndrome begins with a comprehensive perusal of medical history and a physical exam by your doctor. X-rays may be taken to rule out other pathologies. This may show changes in the bone that indicate injury of the rotator cuff muscle. Bone spurs or changes in the normal contour of the bone may also be present

Conservative treatment includes cessation of painful activity, rest and manual therapy. Manual therapy treatments should focus on reducing pain, maintaining/increasing range of motion, improving posture and strengthening shoulder muscles. In addition, your doctor may also utilize the following treatment techniques to improve pain and function: joint mobilization, interferential therapy, soft tissue therapy, kinesiotaping and rotator cuff strengthening. Your doctor may also offer education regarding the cause and mechanism of the condition. NSAIDs and ice packs may be used for pain relief. While it’s important to rest the shoulder joint, you shouldn’t stop movement altogether. Inactivity will cause the muscles to weaken, which will worsen the problem and cause your shoulder to stiffen up. For this reason, a sling is not usually recommended. Therapeutic injections of corticosteroid and local anesthetic may be used for persistent impingement syndrome. A number of surgical interventions are available for patients who do not respond to manual therapy.

 

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