Overview of Shoulder Impingement by Physiotherapist in Tralee

shoulder-ImpingementShoulder impingement is a very common cause of shoulder pain, where a supraspinatus tendon inside the shoulder rubs or catches on nearby tissue and/or bone(acromium) as you lift your arm. Your shoulder is made up of several joints, muscles and tendons which allow the great range of motion in your arm. There are three bones in the shoulder joint: your upper arm bone, your shoulder blade, and your collarbone . Your arm is kept in your shoulder socket by your rotator cuff muscles, along with ligaments and the joint capsule which envelopes the shoulder. There is a lubricating sac called a bursa between the supraspinatus muscle of the rotator cuff where the supraspinatus travels under the bone on top of your shoulder (acromion). The bursa allows the supraspinatus tendon to glide freely under the acromium when you move your arm. When the bursa becomes swollen and inflamed, the condition is called bursitis and is one cause of shoulder impingement. Bone spurs within the shoulder joint can also contribute to impingement, as can forward curving shoulders due to years of bad posture. Sometimes due to impingement and/or bone spurs the supraspinatus muscle or tendon can tear. It can also happen during an accident like a shoulder dislocation or falling on a shoulder etc. Those who do repetitive lifting or overhead activities using the arm, such as paper hanging, construction, or painting are also susceptible.


Symptoms of shoulder impingement

You may have pain and stiffness when you lift your arm. There may also be pain when the arm is lowered from an elevated position. Early symptoms may be mild. Patients frequently do not seek treatment at an early stage. These symptoms may include:

  • Minor pain that is present both with activity and at rest
  • Pain radiating from the front of the shoulder to the side of the arm
  • Sudden pain with lifting and reaching movements
  • Athletes in overhead sports may have pain when throwing or serving a tennis ball

As the problem progresses, the symptoms increase:

  • Pain at night
  • Loss of strength and motion
  • Difficulty doing activities that place the arm behind the back, such as buttoning or zippering

If the pain comes on suddenly, the shoulder may be severely tender. All movement may be limited and painful.


Imaging Tests

Other tests which may help your doctor confirm your diagnosis include:

X-rays. Becauses x-rays do not show the soft tissues of your shoulder like the rotator cuff, plain x-rays of a shoulder with rotator cuff pain are usually normal or may show a small bone spur. A special x-ray view, called an “outlet view,” sometimes will show a small bone spur on the front edge of the acromion.

Magnetic resonance imaging (MRI) and ultrasound. These studies can create better images of soft tissues like the rotator cuff tendons. They can show fluid or inflammation in the bursa and rotator cuff. In some cases, partial tearing of the rotator cuff will be seen.


The goal of treatment is to reduce pain and restore function. In planning your treatment, your doctor will consider your age, activity level, and general health.

TreatmentIn cases where there is a tear in the supraspinatus muscle or tendon, conservative treatment such as rest, physio etc rarely works. In milder cases rest along with rehab and correction of postural problems in the shoulder may work.Rest. Your doctor may suggest rest and activity modification, such as avoiding overhead activities.

Non-steroidal anti-inflammatory medicines. Drugs like ibuprofen and naproxen reduce pain and swelling in mild cases.

Physical therapy. A physical therapist will initially focus on restoring normal motion to your shoulder. Stretching exercises to improve range of motion are very helpful. If you have difficulty reaching behind your back, you may have developed tightness of the posterior capsule of the shoulder (capsule refers to the inner lining of the shoulder and posterior refers to the back of the shoulder). Specific stretching of the posterior capsule can be very effective in relieving pain in the shoulder.

Once your pain is improving, your therapist can start you on a strengthening program for the rotator cuff muscles.

Steroid injection.  Cortisone is a very effective anti-inflammatory medicine. Injecting it into the bursa beneath the acromion can relieve pain and reduce symptoms dramatically if the sole cause of the impingement is bursitis.


Surgical Treatment

When nonsurgical treatment does not relieve pain, your doctor may reoved. This is also known as a subacromial decompression. These procedures can be performed using either an arthroscopic or open technique.

Arthroscopic technique. In arthroscopy, thin surgical instruments are inserted into two or three small puncture wounds around your shoulder. Your doctor examines your shoulder through a fiberoptic scope connected to a television camera. He or she guides the small instruments using a video monitor, and removes bone and soft tissue. In most cases, the front edge of the acromion is removed along with some of the bursal tissue.

Your surgeon may also treat other conditions present in the shoulder at the time of surgery. These can include arthritis between the clavicle (collarbone) and the acromion (acromioclavicular arthritis), inflammation of the biceps tendon (biceps tendonitis), or a partial rotator cuff tear.

Open surgical technique. In open surgery, your doctor will make a small incision in the front of your shoulder. This allows your doctor to see the acromion and rotator cuff directly.

Rehabilitation. After surgery, your arm may be placed in a sling for a short period of time. This allows for early healing. As soon as your comfort allows, your doctor will remove the sling to begin exercise and use of the arm.


Physiotherapists in Tralee, Co. Kerry for all your physiotherapy needs. Phone 0867700191