Feeling the Pinch? The Stubborn Shoulder Impingement Syndrome

Feeling The Pinch? The Stubborn Shoulder Impingement Syndrome

At Worthing Osteopathic & Wellbeing Clinic, we understand how frustrating and debilitating shoulder pain can be, especially when it disrupts your daily activities like brushing your hair, putting on clothes, or even showering. If you experience sharp pain in your shoulder during movements that involve raising your arm to the side and upwards, you may be dealing with Shoulder Impingement Syndrome (SIS). This condition is characterized by a sudden “catch” of pain in the shoulder as you move your arm, often followed by a period of relief as you continue the motion.

Shoulder Impingement Syndrome occurs when the tendons of the rotator cuff muscles, which stabilize your shoulder, become trapped in the narrow bony space of the sub-acromial area. Repeated pinching and irritation of these tendons and the bursa (a cushioning sac under the shoulder bone) can lead to significant pain and injury.

Understanding Shoulder Impingement Syndrome

Shoulder complaints rank as the third most common musculoskeletal issue after back and neck disorders, with the highest incidence among women and people aged 45-64 years. SIS is the most common shoulder injury, accounting for 36% of all shoulder disorders.

Normally, your shoulder should function without any impingement. However, when impingement occurs, it can lead to conditions such as rotator cuff tendonitis (inflammation of the tendon) or shoulder bursitis (inflammation of the bursa). These conditions can occur independently or together, exacerbating the pain and discomfort.

The severity of the injury can range from mild tendonitis and bursitis to more severe issues like calcific tendonitis (bone forming within the tendon) or partial and full-thickness tendon tears, which may require surgery. Over time, repeated irritation can cause the tendons to thicken, further narrowing the sub-acromial space and perpetuating the problem. In some cases, the tendons may degenerate and experience reduced circulation, leading to chronic tendinosis.

Causes of Shoulder Impingement

Shoulder Impingement Syndrome typically results from repeated overhead movements that place the rotator cuff in contact with the outer tip of the shoulder blade (acromion). This repeated contact can trap and pinch the swollen tendon under the acromion, a condition often referred to as “Swimmer’s Shoulder” or “Thrower’s Shoulder.” It can also result from everyday activities like hanging laundry or repetitive tasks at work. In some cases, traumatic injuries like falls can trigger SIS.

The causes of shoulder impingement can be categorized into primary (structural) and secondary (posture and movement-related) factors:

• Primary Rotator Cuff Impingement: This occurs due to structural narrowing of the space where the tendons glide, often caused by conditions like osteoarthritis, which can lead to bony spurs that further narrow the space and increase the risk of impingement.
• Secondary Rotator Cuff Impingement: This type is due to instability in the shoulder girdle, resulting from excessive joint movement, ligament laxity, and muscle weakness. Poor stabilization of the shoulder blade alters the position of the bones, increasing the risk of tendon impingement. Contributing factors include overuse of the rotator cuff tendons (e.g., in sports like swimming or throwing) and muscle imbalances.

Symptoms of Shoulder Impingement

Common symptoms of rotator cuff impingement include:

• An arc of shoulder pain when your arm is at shoulder height or overhead.
• Pain extending from the top of the shoulder down the arm to the elbow.
• Pain when lying on the affected shoulder, leading to night pain and disturbed sleep.
• Shoulder pain at rest as the condition worsens.
• Muscle weakness or pain when reaching or lifting.
• Pain when putting your hand behind your back or head.
• Pain when reaching for a seatbelt or out of the car window.

Who is at Risk?

Shoulder impingement is more likely in individuals who engage in activities requiring repeated overhead arm movements, such as tennis, golf, swimming, weight lifting, or throwing sports. Occupations involving repeated overhead lifting or work at shoulder height also increase the risk.

Diagnosis and Treatment at Worthing Osteopathic & Wellbeing Clinic

At Worthing Osteopathic & Wellbeing Clinic, our experienced therapists diagnose shoulder impingement through specific manual tests and, if necessary, imaging such as ultrasound or X-rays to detect associated injuries like bursitis, tendon tears, or calcific tendonitis.

Treatment involves a multi-stage approach tailored to the severity and cause of the impingement:

1. Early Injury Management: Protect the shoulder, relieve pain, and reduce inflammation.
2. Regain Full Shoulder Range of Motion: Focus on restoring normal movement.
3. Restore Scapular Control and Scapulohumeral Rhythm: Address shoulder blade stabilization.
4. Correct Posture and Shoulder Function: Ensure proper alignment and function of the neck, scapula, and shoulder.
5. Restore Rotator Cuff Strength: Strengthen the muscles supporting the shoulder.
6. Advanced Rehabilitation: Incorporate exercises for high-speed, power, proprioception, and agility.
7. Return to Sport or Work: Gradual reintroduction to activities.

Manual therapy, including massage and mobilization, is essential in the early stages to relieve pain and restore normal shoulder movement. Additional therapies like strapping/taping, ultrasound, and laser therapy may also be beneficial. Rehabilitation exercises specific to your shoulder, posture, and activity demands are key to long-term recovery.

For cases where conservative treatment doesn’t provide sufficient relief, corticosteroid injections may be considered, but it’s crucial to continue with rehabilitation to prevent recurrence once the pain subsides.

Overcoming Shoulder Impingement

While some shoulder impingements respond quickly to treatment, others can be stubborn and require 3-6 months to resolve fully. Progression through treatment stages must be carefully monitored to avoid re-injury and ensure a successful recovery.

For personalized advice and treatment for shoulder impingement, contact Worthing Osteopathic & Wellbeing Clinic today on 01903 366260. Our expert team is here to help you regain pain-free movement and prevent future injuries.