If moving your shoulder or rotating your arm is painful, then you might be dealing with shoulder impingement syndrome, or as it is sometimes called “swimmer’s shoulder”.
Shoulder pain is a common issue for many people, since your shoulder is a complex and delicately balanced structure that requires significant expertise to diagnose and repair problems.
If you think shoulder impingement or a related problem might be your issue, then you should consult an orthopaedic surgeon who is experienced with shoulder and arm injuries and pain.
What is shoulder impingement?
Shoulder impingement is a painful condition where your shoulder’s bursa sac and rotator cuff tendons are both trapped and compressed during arm movements, particularly when the shoulder is elevated or when you raise your arm above shoulder height, over your head, across your chest, or behind your back.
In general, when you raise your arm to shoulder height or above, the space between the scapula bone and rotator cuff tendons and muscles becomes more narrow, which means the acromion process (acromion pain) when moving your shoulder “impinges on” or rubs against the bursa sac and tendons, which is what causes the pain if you have shoulder impingement syndrome or impingement syndrome shoulder.
If left untreated, the tendons in your shoulder can tear, which means you’ll have a torn rotator cuff, a bicep tear or similar problems that can be much more painful, long lasting, and complicated to fix.
The muscles of the shoulder
Your shoulder joint consists of two bones – the scapula and humerus – that make up the ball and socket along with four rotator cuff muscles – the subscapularis, supraspinatus, infraspinatus, and the teres minor.
These bones control the shoulder blade or socket (the scapula bone), forming a band or cuff around the ball (the humerus bone). Your shoulder joints are delicate and complex structures so any pain or problems should be taken seriously.
What causes an impinged shoulder?
Shoulder impingement can occur for many different reasons, from acute injuries to the shoulder joint and upper arm (common in athletes in sports like football, rugby, tennis, and swimming) to repetitive use problems that degrade or damage the shoulder joint over time.
Normal shoulder function means that there is little impact of the scapula bone on the bursa sac or rotator cuff, but if your shoulder muscles are damaged or weak, then your movement pattern changes and can cause shoulder impingement issues, along with other problems.
If your shoulder bursa sacs or rotator cuffs are repeatedly pinched, they become inflamed, causing shoulder impingement, among other conditions.
The signs and symptoms of shoulder impingement
Some of the more common symptoms of shoulder impingement include pain or a “clicking” feeling when you’re placing your hand behind your head or back or pain when reaching across your chest (think putting on a seat belt or even folding your arms at the elbow).
Pain when lying on the shoulder or muscle weakness when you’re attempting to reach, grab, or lift something with the affected arm is also a sign of shoulder impingement syndrome or a similar issue.
Shoulder impingement syndrome
If you’ve been diagnosed with shoulder impingement syndrome, you should know that you are at greater risk for shoulder bursitis or a structural shoulder injury or tear, so following instructions from your doctor, physiotherapist, and other healthcare professionals is extra important.
How is shoulder impingement diagnosed?
Shoulder impingement is typically diagnosed by an orthopaedic surgeon after a referral from another physician or a physiotherapist.
They can perform a series of tests that include checking your range of motion, rotator cuff strength, scapular influence on the impingement, and any other necessary tests to determine the range of impingement.
Ultrasound scans are also used to diagnosed many shoulder conditions, including shoulder impingement, including real time ultrasounds where you move your arm and shoulder while the technician watches to see what happens as your shoulder moves through the impingement zone.
MRIs and X-rays are unlikely to show shoulder impingement dynamically, but may be helpful for diagnosing the condition.
A plain and simple X-ray might show a reduced space (subacromial space) that is causing the impingement. Common causes like a hook or spur of the acromion can be identified on these films.
An MRI is helpful in highlighting oedema and fluid from a tight space and can also define the anatomy clearly. The MRI scan also assesses all the other potential structures in the shoulder that could be diseased and causing symptoms.
Ask your doctor about the necessary tests depending on the types of pain you are experiencing – they will be able to order the required imaging to diagnose your shoulder pain or condition.
What issues are similar to shoulder impingement?
Shoulder impingement or rotator cuff impingement is one spectrum of a group of shoulder conditions that includes rotator cuff tendonitis and subacromial bursitis.
In all cases, the rotator cuff tendons can be irritated or damaged, the shoulder bursa sacs can become inflamed and swell, causing pain and further damage if left untreated.
This is why if you think you are suffering from shoulder impingement, rotator cuff pain, acromial pain, or any similar problem, it’s important to consult with an orthopaedic surgeon as soon as possible.
How to fix shoulder impingement?
Depending on the severity of the issue, there are a number of ways to help relieve shoulder impingement.
Non-surgical treatments may be advised in less severe cases, but surgery is an option that can be explored depending on your condition and any other shoulder issues you may be suffering from.
Non-surgical treatment for shoulder impingement
Perhaps the most important aspect when treating shoulder impingement is understanding why it happened – a long term repetitive use injury versus a more sudden acute injury tends to result in a different course of action.
In many cases, non-surgical treatment is enough to treat shoulder impingement syndrome.
More minor cases may not require surgical intervention, but rather physiotherapy, icing the affected joint, and similar anti-inflammatory treatments along with pain relief medication may all go a long way towards treating shoulder impingement syndrome.
Steroidal medications and injections may also be prescribed depending on your specific situation.
A targeted subacromial injection with steroid and local anaesthetic might help with the inflammation and also you to attend to regular physiotherapy and exercises for shoulder impingement to change the dynamics of your shoulder and scapula to help the condition.
Naturally, you should always consult with your orthopaedic surgeon and do not return to your standard activities without their okay.
Shoulder impingement surgery
Surgery is not always required for shoulder impingement syndrome, but severe cases and cases that do not resolve with non-operative options may require surgery, especially when coupled with other injuries.
Arthroscopic key-hole techniques are possible in many cases, but open surgery may be required if your shoulder issues or injuries are particularly severe. This is extremely uncommon.
For more significant shoulder impingement or cases that result from acute injury, surgery may be required, particularly if the individual suffering from the issues is younger and suffering from few other physical problems.
There are a range of surgical options depending on the severity of the case, many of which are outpatient procedures so the recovery time will be relatively minimal.
Shoulder impingement surgery recovery time
Recovering from shoulder surgery can be easier than you think, but do keep in mind that you’ll be somewhat impaired and won’t be able to lift with your affected arm, so try to set things up and get help from a trusted family member or friend if you can.
You may also need to keep your arm in a sling for a period of time.
After you’ve had surgery or other treatment for shoulder impingement syndrome, you’ll be required to do physiotherapy and shoulder impingement exercises to strengthen the damaged shoulder joint and get your full range of movement back (or at least as much as possible).
This involves low impact exercises that help to stabilize your shoulder joint and are performed under the supervision of a physiotherapist – your orthopaedic surgeon will likely have physiotherapists that they work with and can recommend.
Some of the different techniques that physiotherapists will use include joint mobilizations (this is essentially moving the shoulder joint through a series of positions that are meant to improve rotation and flexibility), massage, ultrasound treatments, icing the joint, applying heat to the joint, stability exercises, and strengthening exercises.
You may also be given an exercise routine to do at home once you’ve recovered more.
If you’ve had shoulder impingement surgery or any kind of shoulder surgery or issue, you should understand that once you’ve injured your rotator cuff, it’s more likely to happen again in the future.
Be realistic about your capabilities and how quickly your shoulder is healing, and follow the advice of your doctor, trainers, and physiotherapists.
Be warned that it may require about two to four months to recover a full range of motion and potentially a year for complete pain relief, but with a good orthopaedic the treatment will be worth it.
You only get two shoulders (and generally one dominant one) in your lifetime, so take care of them.
How to prevent rotator cuff impingement syndrome
Rotator cuff syndrome, shoulder impingement and general shoulder injuries are a fairly common shoulder problems for super active individuals, especially amongst athletes who play sports like rugby, football, tennis, and other sports that involve a lot of overhead motion, such as swimming (e.g. the aforementioned swimmer’s shoulder problem).
Individuals who work in construction or other significantly physical jobs also experience this problem – anything that involves raising your arms over your head regularly can cause shoulder damage.
If you think you’re dealing with shoulder pain impingement or a similar or related, talk to your doctor and an orthopaedic surgeon as soon as possible. An ounce of prevention is worth a pound of cure.