Symptoms

Some of the common symptoms of shoulder impingement include shoulder pain, particularly during overhead movements or activities that involve reaching, lifting, or throwing. The pain may radiate down the arm and worsen at night. Individuals with shoulder impingement may also experience weakness in the affected shoulder, limited range of motion, and difficulty in performing daily tasks. It’s important to seek medical attention if these symptoms are present to receive a proper diagnosis and appropriate treatment. Early intervention can help alleviate symptoms, prevent further complications, and restore normal shoulder function.

Causes and Risk Factors

Shoulder impingement can occur due to various reasons. Some of these reasons include:
 

• Repetitive overhead activities: Engaging in sports or occupations that involve repetitive overhead motions, such as swimming, tennis, or baseball, can strain the tendons and bursa in the shoulder joint. Over time, this repetitive stress can lead to inflammation, irritation, and impingement.
• Poor posture: Maintaining poor posture, especially rounded shoulders and forward head posture, can alter the alignment of the shoulder joint. This misalignment reduces the available space for movement, increasing the risk of impingement. Poor posture places unnecessary stress on the tendons and bursa, contributing to their compression and irritation.
• Structural abnormalities: Some individuals may have structural variations in their shoulder joints, such as a hooked or curved acromion. These variations can narrow the subacromial space, which is the area where the tendons pass through. A reduced space increases the likelihood of the tendons getting pinched or compressed during movement, leading to impingement.
• Muscle imbalances: Imbalances in muscle strength and flexibility can affect the stability and movement of the shoulder joint. Weakness in the rotator cuff muscles, which are responsible for stabilising the shoulder, can lead to improper alignment and increased stress on the tendons. Additionally, tightness in the chest and upper back muscles can pull the shoulder forward, further narrowing the space and contributing to impingement.
• Age-related changes: As we age, the tendons and bursa in the shoulder joint naturally become less flexible and more prone to degenerative changes. This can result in decreased space within the joint, making impingement more likely. Age-related changes, combined with other factors, increase the vulnerability to shoulder impingement.

Understanding and addressing these causes and risk factors can help individuals modify their activities, improve posture, strengthen muscles, and seek appropriate treatment to manage or prevent shoulder impingement.
 

Diagnosis

The diagnosis of shoulder impingement typically involves a comprehensive evaluation by a healthcare professional. This process begins with gathering the patient’s medical history, discussing symptoms, previous shoulder injuries, and treatments. A thorough physical examination of the shoulder joint is then conducted to assess range of motion, strength, and stability.
 
To confirm the diagnosis and evaluate the condition further, imaging tests such as X-rays, MRI, or ultrasound may be recommended to help assess the bone structure and soft tissues for signs of inflammation or impingement. In some cases, diagnostic injections may be administered, where a local anaesthetic is injected into the subacromial space to alleviate pain temporarily and determine if impingement is the likely cause. Through a comprehensive evaluation, healthcare providers can accurately diagnose your condition and determine the appropriate course of treatment.

 

Treatment

The treatment for shoulder impingement aims to reduce pain, inflammation, and restore normal shoulder function. The specific treatment approach will depend on the severity of the impingement, the individual’s symptoms, and their overall health. Common treatment options include:

• Rest and activity modification: Initially, it is important to rest the shoulder and avoid activities that aggravate the symptoms. Modifying or avoiding repetitive overhead movements and activities can help alleviate stress on the shoulder joint.
• Physical therapy: Physical therapy plays a crucial role in the management of shoulder impingement. A physical therapist will design a personalised exercise programme to strengthen the muscles around the shoulder joint, improve flexibility, and correct any muscle imbalances. They may also use techniques such as manual therapy, ultrasound, or electrical stimulation to reduce pain and inflammation.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation in the shoulder. These medications can help manage symptoms and improve comfort.
• Corticosteroid injections: In some cases, corticosteroid injections may be used to provide short-term relief from pain and inflammation. The injection is directly administered into the subacromial space to target the affected area.
• Surgical intervention: If conservative treatments do not provide sufficient relief, or if there is structural damage in the shoulder, surgical intervention may be considered. Arthroscopic surgery is a common approach for shoulder impingement. It involves using small incisions and a tiny camera to remove any impinging structures, repair damaged tendons, or correct structural abnormalities in the shoulder joint.
• Rehabilitation: Following surgery or in cases where conservative treatments are unsuccessful, a rehabilitation programme is typically prescribed. This involves a gradual progression of exercises and activities to restore strength, flexibility, and function to the shoulder joint.