Is my shoulder pain due to impingement?

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Shoulder pain is a common presentation at our Chiro & Physio clinic in Marrickville. In today's post, we will be focusing on the symptoms and causes of shoulder impingement.

What is shoulder impingement?

Shoulder impingement is one of the most prevalent shoulder injuries. Your shoulder is made up of numerous joints, tendons, and muscles that provide your arm a wide range of motion. Because the shoulder is made up of so many distinct components, it is susceptible to a variety of disorders. The rotator cuff tendonitis is a common cause of impingement due to increased inflammation. Other structures such as biceps tendon, shoulder bursae and joints can also be inflamed, causing restricted movement and pain. In this article, discuss in depth on the causes, mechanics and how physical therapy and chiropractic treatments can help.

Symptoms

Individuals with shoulder impingement often report pain at the front, top and back of their shoulder, especially when they lift their arm overhead or backwards. They may also experience:

• Generalised shoulder aches
• Pain that goes from the front of the shoulder to the side of the arm
• Difficulty sleeping because of pain
• Shoulder or arm weakness with the reduced ability to raise the arm overhead
• Catching sensation when raising the arm overhead

Although shoulder impingement is an overarching term for when any of the structures around the glenohumeral joint are irritated, there are some structures that may be more affected than others.

These vary depending on presentation, and mainly include:

Rotator Cuff

The rotator cuff muscles are a set of four muscles that stabilise the shoulder joint, and help lift and rotate the arm. The rotator cuff, especially the supraspinatus tendon, runs between a narrow space between the acromion and humerus. This arrangement makes the tendon susceptible to being ‘pinched’ or impinged between these bones, which creates irritation and swelling. Like a vicious cycle, the rubbing between these bones causes swelling, which then further narrows the space between the acromion.

This phenomenon commonly occurs with:

• Repetitive overhead movements especially in swimmers, cricketers, volleyballers
• Occupational movements that involve heavy lifting and overhead movements such as construction work and painting
• Weakness in the rotator cuff muscles which leads to a downward migration of the humeral head. As a result, the acromial space is narrowed which creates increased chances of impingement.
• Rotator cuff tendinopathy which is a pathology of the tendons. This results in a thickening of the tendons which narrows the acromial space.
• Rotator cuff tears or sprains which may be due to an acute shoulder injury. The muscle belly thickens as the healing inflammation process occurs which also narrows the acromial space.

Bursitis

You may have a had a shoulder scan that reported a subacromial or subdeltoid bursitis. A bursa is a liquid-filled sac that can be found between tissues (bone, skin, tendons and muscle). Because of this fluid, the bursa can act as a cushion, reducing friction and irritation between tissues that move against one other.

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When the bursae are not inflamed, joints move easily and painlessly. However, when it gets irritated and swollen, Chiropractic, Physiotherapy or Osteopathy can be effective in reducing the pain.

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Biomechanical Dysfunctions

Biomechanical dysfunction in the shoulder due to muscular imbalance or injury can lead to wear and tear of certain structures which in turn causes irritation and discomfort. The two common types we see are:

1. Scapular Dyskinesis

Shoulder dyskinesis is when pain in the shoulder is caused by dysfunction in scapula movement. The scapula, often known as the shoulder blade, is a triangular-shaped bone in the upper back. A complex system of muscles surrounds and supports the bone, which works together to enable you to move your arm. The posture of the scapula at rest or in motion might be altered if these muscles become weak or unbalanced as a result of an injury or disease.

2. Upper Cross Syndrome

This condition typically presents with rolled shoulders, forward head position and tight shoulder and neck muscles.

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The main cause of this syndrome is due to the increased prevalence of technology where we see many people on their phones and computer devices for prolonged periods of time. Over a long period of time, this can lead to headaches and muscular ache.

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Due to the multiple causes of shoulder impingement, it is important to be thoroughly assessed and be provided an individual treatment plan. Our Chiropractor and Physiotherapist at Hyper Health are able to effectively treat shoulder impingement disorders. Our clinic is located in Marrickville, servicing the Inner West suburbs of Sydney. If you have any further questions about how we can help with your shoulder, head over to our Contact Us page, or book in now to make an appointment.

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