Shoulder Impingement Syndrome
Shoulder pain and injuries are becoming more prevalent in physiotherapy – for most people what begins as an uncomfortable shoulder ache and pain fades away on it’s own, but for others it continues and the pain becomes more persistent and intense, proceeding to a point where there is noticeable loss of shoulder function with day to day activities such as dressing and cleaning. Moreover, the loss in shoulder function also has an effect on peoples work and/or recreational activities, the end result being people suffering from shoulder impingement.
Shoulder impingement syndrome is the compression and irritation of one or more of the following structures in the shoulder under the acromial arch: rotator cuff tendons, subacromial bursa, and biceps tendon. Usually the signs and symptoms of shoulder impingement syndrome include pain/stiffness (especially with arm elevation and overhead activities), decreased mobility and function (reaching behind your back), weakness and pain at night. Pain can vary depending on the severity of the impingement – initially starts off as a dull ache with tenderness in the shoulder to sharp pain with certain movement of the shoulder that radiates.
Shoulder impingement can occur in any age group and can be the result of repetitive overhead shoulder movements often seen in athletes i.e. swimmers, baseball players and from repetitive job duties especially for those who work in construction, painters, assembly line workers etc. Sudden injury to the shoulder can also lead to the development of shoulder impingement syndrome if left untreated and the individual continue to do activities which may exacerbate symptoms. There are several other factors that can play part in contributing to an impingement syndrome such as posture, degenerative changes to the shoulder girdle, and muscle imbalances to name a few.
Management of shoulder impingement involves the following:
- Rest and activity modification: shoulder movements (overhead and repetitive in nature) that further aggravate the shoulder pain are avoided. Use of a NSAID and ice can further help alleviate some of the symptoms
- Physiotherapy is effective in the treatment of shoulder impingement:
- TENS/IFC, Laser/ultrasound treatments for pain and symptomatic relief
- Manual therapy (joint mobilizations, stretching)
- Therapeutic exercises for ROM, strengthening and conditioning
- Patient education (posture/ergonomics)
- Home-based exercise program