Shoulder Impingement : Simplified

Shoulder Impingement – Causes & Treatment

The term impingement itself explains some kind of pinching or compression in shoulder joint. Most common location of shoulder impingement is under the sub acromion arch followed by less common sub coracoid impingement.

Sub acromion arch is formed by clavicle (collar bone) and acromion process of scapulae (shoulder blade). The space below sub acromion arch comprises of one of the rotator cuff muscle (supraspinatus) and a bursae which sits over the head of humerus (arm bone). If the space between sub acromion arch and head of humerus decrease it causes compression and irritation of supraspinatus muscle and the bursae.

 

It is more common in middle aged group but can also be seen in active sporting individuals at young age. Usually, the symptoms are pain, stiffness and clicking. Pain is worse with overhead arm movements and sleeping on the affected shoulder. Location of pain is around tip of the shoulder and might refer down till mid arm on outer side. Hand behind back might also be painful in some cases.

In sub coracoid impingement the affected muscle is another rotator cuff muscle (subscapularis). Location of symptoms is more in front of the shoulder as compared to subacromion impingement.

Causes

  • Poor posture – protracted shoulders, thoracic kyphosis (hunch back)
  • Stiff and decreased mobility in thoracic area
  • Altered position and movement of scapula
  • Tight and overactive pectorals muscles and deltoids
  • Weak rotator cuff muscles and scapular stabilizers
  • Repetitive overhead movements
  • Poor sporting technique
  • Involvement in activities performed away from body (painting , desk work)
  • Type II and Type III acromion (Curved or hooked acromion)
  • Development of  a bone spur on front or side of acromion

 

 Conservative treatment

  • Posture correction
  • Ergonomic advice – workplace setup
  • Strengthening scapular stabilizers and rotator cuff muscles
  • Stretching exercises for tight muscles(e.g.: pectorals)
  • Soft tissue mobilization
  • Joint mobilization
  • Sporting technique correction
  • Improving overall core strength and control to reduce stress on shoulder in activities like throwing, smashing.
  • Taping
  • Icing to reduce inflammation
  • Correcting sleeping position

 

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