What is shoulder impingement syndrome?
Shoulder impingement syndrome is a common name given for a condition that causes shoulder joint pain and most often upper arm pain. This problem is typically associated with rotator cuff pathology and/or bursitis of the shoulder. This syndrome is often a sign that there is an underlying problem with one of those structures but could be related to other things as well. This article will discuss what you need to know about this painful condition.
The shoulder joint is a complex structure consisting of several muscles, bones, ligaments and a bursal sac. All of these structures act together to allow the joint the great flexibility and motion that it has. Because of its intricate design it is prone to injury. The more common injuries will occur to the soft tissue structures (the muscles and bursa). When these structures are injured they will become inflamed and this starts a painful process.
How does it occur?
Shoulder impingement syndrome occurs when one or more of the soft tissue structures becomes inflamed when injured. This inflammation causes a swelling in the area and reduces the space that these structures have to move around. The rotator cuff muscles and the bursal sac are very close to a piece of bone that is part of the shoulder blade. They actually sit right beneath it. As they swell the space between them and this bone becomes less and less. As you try to raise your arm overhead these swollen structures will get pinched (or impinged) under this bone and shoulder joint pain. This is how the impingement syndrome starts.
As the swelling worsens other motions will become painful as well such as reaching behind your back, pulling up your pants, or putting on a shirt. Weakness may develop over time as well. These are all common symptoms caused by this condition. If the pain and inflammation persists for a long period of time it can cause minor tears in the muscles which may eventually lead to a major tear. Once this happens your ability to raise your arm or use it normally will be markedly impaired.
How is this syndrome diagnosed?
A qualified physician or physical therapist can make the diagnosis of shoulder impingement syndrome. This starts with a thorough exam and medical history. Often times the MD will order x-rays to rule out a more serious problem. There are a series of tests including range of motion, muscle testing and special testing that are performed to identify this problem. The physician may also attempt and injection into the joint to see if it relieves the pain. If so then the diagnosis is confirmed.
What treatments are available for this problem?
Most treatment will focus on relieving your pain but you must understand that there is an underlying cause as to why this happened. This might include muscle weakness in the shoulder or shoulder blade, tightness in certain structures or an unstable shoulder. A qualified physician or physical therapist can determine this for you.
Shoulder joint pain is treated with anti-inflammatory medication. This must be taken for several weeks (up to 8) to notice a positive effect. You have to let your MD know if the meds aren’t helping within 2 weeks or so. If they aren’t he may prescribe a different form of anti-inflammatory. Persistent pain that is not relieved with meds or structured exercises may lead to a cortisone injection. This may or may not relieve the pain but it does not treat the underlying cause of the problem.
A core component to treating shoulder impingement syndrome is to perform a structured exercise program consisting of specific exercises designed to restore strength, improve flexibility and to restore the normal mechanics of the shoulder. It is not wise to perform random exercises given to you by a friend or coworker. The exercise program you perform must be specifically tailored for this condition.
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