Shoulder Impingement

Shoulder impingement is a common shoulder problem. Every time when the shoulder is sore, most people would think it is frozen shoulder. Most doctors would prescribe pain killer and anti-inflammatory medications. Some of them would even give advices on some exercise or refer to physiotherapist for treatment other than medications. In fact, shoulder impingement is much more common than frozen shoulder. But, if shoulder impingement is not properly managed, it can lead to frozen shoulder when the problem is serious.

The common symptoms of shoulder impingement are pain and difficulty to perform tasks above head level. Pain is usually located at the outside or the front of shoulder. Shoulder muscles would feel weak. Many people would also experience pain when raising arm to shoulder level. More serious cases would even have difficulty to take the wallet out of back pocket.

The cause of shoulder impingement is usually due to the humerus bone (upper arm) hitting part of shoulder blade or collar bone, leading to compression of biceps tendon or supraspinatus (one of the rotator cuff muscles) tendon between bones. Eventually this compressive force would irritate the tendon causing inflammation. The blood circulation at this area would also be affected. Therefore, the tendon can gradually weaken. If symptom is worsening over a period of time, it can lead to tendon tear. Then surgical repair is required if the tendon is torn completely. The cause of humerus bone hitting other bones can differ from person to person. It is usually due to shoulder muscles imbalance, tight shoulder joint capsule or bony spur at shoulder joint. This type of problem is quite common among people doing jobs requiring repetitive arm lifting tasks and also in base ball players and swimmers.

In order to diagnose shoulder impingement, Doctor usually requires understanding of your symptoms and history. X-ray might be required to check for arthritis and bony spurs. Sometimes an ultrasound of the shoulder is needed to check for tear of tendon. You can also seek advices from your physiotherapist. Through detailed examination, the cause of shoulder impingement, whether due to muscle or joint problems, can be identified. Your physiotherapist can provide you with appropriate treatment and exercise regime to reverse the problem of shoulder impingement. This involves the loosening of tight muscles and stiff joints. In addition, strengthening of the shoulder stabilizing muscles (lower trapezius and rotator cuff muscles) is quite critical to maintain the correct positioning of the shoulder joint. This will further minimize the pinching effect on the damaged tendon. Following advices from the physiotherapist and doing prescribed exercises regularly can assist in settling down the inflammation and pain dramatically. Gradually, difficult shoulder movements will be freer again. If the shoulder condition is well maintained in the long term, the chance for recurrence of shoulder impingement will be greatly reduced.

If there is severe bony spur problem in the shoulder joint, then surgery is required to remove the spur in order to improve the amount of space within the joint allowing the tendon to move freely without being pinched or rubbed. You can ask your physiotherapist if there is further question.