Shoulder Impingement: Causes, Symptoms, and Treatment

By Kamal I. Bohsali MD

Getting to Know Shoulder Impingement

Shoulder impingement is a fairly common condition that can cause discomfort and restricted movement in the shoulder. It arises when the tendons of the rotator cuff become inflamed or irritated as they pass through the tight space between the top of your shoulder blade and the upper arm bone. To understand shoulder impingement better, it’s helpful to know a little about the structure of the shoulder, what might cause this condition, how it’s diagnosed, and what treatment options are available.

Impingement of the Shoulder – Anatomy

A general discussion of the anatomy of the shoulder is necessary to understand what causes impingement of the shoulder. Your shoulder is made up of three distinct bones. These muscles and tendons form a blanket around the head of the upper humerus and attach it to the scapula. There is fluid filled sac called a bursa between the rotator cuff and the bony structure on top of your shoulder or acromion. The bursa reduces the amount of friction and allows the rotator cuff tendons to move easily when moving the arm.

The shoulder joint is a complex arrangement that gives us a great deal of flexibility and range of motion. It’s important to understand its structure to get a handle on conditions like shoulder impingement.

Your shoulder joint is made up of three bones: the humerus (upper arm bone), the scapula (shoulder blade), and the clavicle (collarbone). These bones form a ball-and-socket joint, which lets your arm move in many different directions.

Shoulder Muscles

The rotator cuff is a key part of the shoulder joint. It’s a group of four muscles and their tendons that wrap around the shoulder joint. These muscles are the supraspinatus, infraspinatus, teres minor, and subscapularis. They play a crucial role in keeping the shoulder stable and facilitating various movements.

Tendons and ligaments are also essential for shoulder movement. Tendons are tough, string-like tissues that link muscles to bones, while ligaments link bones to other bones. In the shoulder, tendons and ligaments work together to provide stability and support while you move.

Understanding the structure and function of the shoulder joint, the rotator cuff, and the role of tendons and ligaments is key to diagnosing and treating shoulder impingement. If you’re experiencing shoulder pain or a limited range of motion, it’s important to see a healthcare professional who can provide a thorough evaluation and recommend appropriate treatment options.

Image of Shoulder Anatomy

Impingement of the Shoulder – Mechanism of Injury

When lifting the arm to shoulder level, the space between the acromion and rotator cuff muscles decrease. The acromion can come into contact with the tendons and the bursa, causing inflammation and subsequent pain. Overhead athletes and weekend warriors alike can develop impingement over time with repetitive shoulder activity.

Image of Rotator Cuff Muscles

What Causes Shoulder Impingement?

Shoulder impingement is a common condition that happens when the tendons and bursa in the shoulder get squeezed or irritated. Several factors can contribute to shoulder impingement, including:

1. Repetitive overhead activities: Taking part in activities that involve a lot of overhead movements, like swimming, tennis, or painting, can increase your risk of shoulder impingement. These activities can put too much stress on the tendons and bursa, leading to inflammation and impingement.

2. Imbalance in shoulder muscles: If some of the muscles around the shoulder joint are stronger or tighter than others, it can change the way the shoulder joint works, causing the tendons to get pinched.  Often in the weight room, athletes will work their anterior shoulder muscles way more that their back of the shoulder muscles.

3. Bone spurs and joint abnormalities: Bone spurs can develop in the shoulder joint as a result of aging or injury. These bony growths can reduce the space within the joint, leading to impingement. Also, joint abnormalities, such as a curved or hooked acromion process, can increase the likelihood of impingement.

If you’re experiencing symptoms of shoulder impingement, it’s important to see a healthcare professional for an accurate diagnosis and appropriate treatment options. At JOI, we offer a range of services for shoulder conditions, including non-surgical treatments, physical therapy, and surgical interventions if necessary. Our team of specialists is committed to helping you find relief and regain full function of your shoulder.

Impingement of the Shoulder – Symptoms

If you’re feeling pain and discomfort in your shoulder, you might have shoulder impingement. This condition happens when the tendons in your shoulder get irritated or inflamed, causing pain and restricted movement.

A common symptom of shoulder impingement is pain that gets worse with certain movements or activities, such as reaching overhead or lifting heavy objects. The pain may be sharp or dull and can spread down the arm. You may also experience an aching or throbbing sensation in your shoulder.

Another sign of shoulder impingement is a limited range of motion. You might find it difficult to lift your arm above your head or reach behind your back. Activities that require reaching, lifting, or carrying objects may become difficult due to the restricted movement.

Physical Examination

If you think you might have shoulder impingement, it’s important to get a proper diagnosis. A healthcare professional will carry out a physical exam to check your shoulder’s range of motion, strength, and any signs of inflammation or tenderness. They may also order diagnostic tests, such as an X-ray, MRI, or ultrasound, to get a closer look at the structures within your shoulder.

By recognizing the symptoms and getting an accurate diagnosis, you can take the necessary steps to manage and treat shoulder impingement effectively.

Athletes who participate in overhead sport activities may have pain when throwing, serving a tennis ball or bowling. As the problem increases in severity, so too do the symptoms. Pain may be present at night and as well as loss of strength and motion. The individual may have trouble performing basic activities such as hygiene care and putting on clothes. It is important to note that impingement may not occur in isolation.  Rotator cuff tears may be present at the same time.

For more information on shoulder impingement, go to 5 shoulder symptoms you should not ignore.

JOI Rehab Shoulder ROM Exercises

Evaluation By Your Orthopedic Surgeon

Whether by self-referral or by your primary care physician, your orthopaedic surgeon will perform a history and physical exam in addition to x-rays of the shoulder. If necessary, additional imaging such as an MRI may be obtained to evaluate the soft tissues and the rotator cuff in your shoulder.

Impingement of the Shoulder Treatment

The goals of treatment are pain reduction and restored function. With regards to your treatment options, your orthopaedic surgeon considers several factors.  These include age, pre-injury level of activity level, and overall health status. Initial management is typically nonsurgical.

Sidelying Sleeper Stretch

There are several ways to treat shoulder impingement, depending on the severity of the condition and your specific needs. Here are some common treatment approaches:

Conservative approaches:

Resting and avoiding activities that cause shoulder discomfort can be a helpful first step in managing shoulder impingement. Applying ice to the affected area can help reduce inflammation and relieve pain. Physical therapy is often recommended to strengthen the shoulder muscles, improve range of motion, and correct any imbalances or weaknesses that might contribute to impingement. A physical therapist can guide you through exercises and stretches that target the affected area.  Although, this form of treatment may take time, some patients experience improvement of symptoms and function. Examples of this initial treatment include rest, avoidance of overhead activities, and use of oral non-steroidal anti-inflammatory medications. If necessary, a formal outpatient physical therapy regimen may be initiated. If these initial treatments do not work, then your surgeon may opt to perform a steroid injection into the bursa.

Medications and pain management:

In some cases, over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen sodium may be recommended to reduce pain and inflammation.  In more severe cases, your Md may give you prescription medications or corticosteroid injections.  These medications can provide temporary relief, but they do not address the underlying cause of the impingement.  Always consult with your physician before starting new medications.

Surgical interventions:

If conservative approaches and medications do not provide enough relief, surgery may be necessary. Arthroscopy is a minimally invasive procedure that lets the surgeon see and repair any structural abnormalities in the shoulder joint. During arthroscopy, small cuts are made, and a tiny camera is inserted to guide the surgical instruments. Decompression surgery involves removing or reshaping the bone or tissue that is causing impingement, creating more space for the structures in the shoulder joint.

Impingement Surgical Intervention

With arthroscopy, the surgeon uses small surgical implements in two or three small incisions around the shoulder. The surgeon examines the shoulder through a fiberoptic scope connected to a camera. The surgeon performs all aspects of the surgery through the use of the specialized instruments with the video monitor. In a majority of cases, your surgeon needs to remove the anterior or front end of the acromion.  As well as the inflamed bursal tissue. The surgeon will address other problems in the shoulder at the time of intervention. This would include problems such as acromioclavicular arthritis, biceps tendon tears, and rotator cuff tears. In conclusion, if you think that you have impingement, you should seek out a medical evaluation.

Related Articles: Exercises for Shoulder Pain and How To Get Rid of Shoulder Pain.

If you have recently had a shoulder surgery, please watch this helpful video: Dressing the Upper Body After an Injury or Surgery

Image of Dr. Kamal Bohsali