Shoulder Impingement Syndrome:
Thursday July 19th 2012 @ 1:21 pm
Shoulder Impingement Syndrome
Impingement Syndrome is sometimes called Swimmer’s shoulder or Thrower’s shoulder, is caused by the tendons of the rotator cuff becoming impinged as they pass through the shoulder joint.
Symptoms of Impingement Syndrome:
Shoulder pain comes on gradually over a long period
Pain at the front and/or side of the shoulder joint with overhead activity such as throwing, front crawl swimming – most common in external impingements
Pain at the back and/or front of the shoulder when the arm is held out to the side (abducted) and turned outwards (external rotation) – most common in internal impingements
Pain when lifting the arm above 90 degrees
Pain on internal (medial rotation) movements – for example reaching up behind your back
Positive shoulder impingement tests
What is Impingement Syndrome?
Impingement Syndrome, which is sometimes called Swimmer’s shoulder or Thrower’s shoulder, is caused by the tendons of the rotator cuff (supraspinatus, infraspinatus, teres minor and subscapularis muscles) becoming ‘impinged’ as they pass through a narrow bony space called the Subacromial space – so called because it is under the arch of the acromion. With repetitive pinching, the tendon(s) become irritated and inflamed.
This can lead to thickening of the tendon that may cause further problems because there is very little free space, so as the tendons become larger, they are impinged further by the structures of the shoulder joint and the muscles themselves.
Impingement Syndrome in itself is not a diagnosis it’s a clinical sign. There are at least NINE different diagnoses that can cause impingement syndrome. These include:
Rotator cuff injury: The rotator cuff is a group of muscles, which work together to provide the Glenohumeral (shoulder) joint with dynamic stability, helping to control the joint during rotation (hence the name).
Labral injury: The glenoid labrum is a fibrous ring of tissue that attaches to the rim of the glenoid (shallow depression of the scapula or shoulder blade where the ball of the humerus sits). The glenoid labrum increases the depth of the shoulder cavity making the shoulder joint more stable. The glenohumeral ligaments (which secure the upper arm to the shoulder) and shoulder capsule attach to the glenoid labrum.
Shoulder instability: No single structure is responsible for providing stability at the shoulder joint. Instead, the bony structure of the joint surfaces, the ligaments, capsule and muscles are all key components in maintaining a stable shoulder joint yet permitting a large range of movement in several directions.
Instability is often associated with subluxation (partial dislocation of the shoulder joint), which may be associated with pain and / or dead arm sensation. Indeed this is often what prompts the athlete to seek medical attention. In some people, this is not actually painful but can be quite annoying and prevent them from taking part in daily activities or sports.
Instability of the shoulder joint can be in one direction for example, anterior instability (out the front), posterior instability (out the back) or in more than one direction (known as multidirectional instability). The most common form of instability seems to be anterior and is probably because the joint capsule is at its weakest at the front of the joint.
Biceps tendinopathy: The biceps muscle splits into two tendons at the shoulder, a long one and a short one. The long tendon runs over the top of the humerus bone (upper arm) and attaches to the top of the shoulder blade. Inflammation of this tendon is a fairly common complaint especially with swimmers, rowers, throwers, golfers and weight lifters.
Scapula (shoulder blade) movement dysfunctions
If left untreated, shoulder impingement can result in a rotator cuff tear
Impingement Syndrome Classification
1. External impingement
Is usually due to bony abnormalities in the shape of the acromial arch.
Can sometimes be due to congenital abnormalities (known as os acromial), or due to degenerative changes, where small spurs of bone grow out from the arch with age, and impinge on the tendons.
Usually due to poor scapular (shoulder blade) stabilisation that alters the physical position of the acromion, hence causing impingement on the tendons.
Is often due to weak serratus anterior and tight pectoralis minor muscles
Other causes can include weakening of the rotator cuff tendons due to overuse (e.g. throwing and swimming) or muscular imbalance with the deltoid muscle and rotator cuff muscles.
2. Internal impingement
Occurs predominantly in athletes where throwing is the main part of the sport (e.g. pitches in baseball)
The under side of the rotator cuff tendons are impinged against the glenoid labrum – this tends to cause pain at the back of the shoulder joint as well as sometimes at the front.
Treatment of Impingement Syndrome
What can the athlete do?
Apply ice or cold therapy to the painful area for 10-15 minutes per 2-hour period. Remember to use an ice bag or a towel wrapped around the ice to protect against ice burn.
Seek advice from a sports injury professional that can develop an appropriate rehabilitation programme
Return to sport gradually once the pain has eased
What can the sports injury professional or doctor do?
Carry out specific tests and/or order X-Rays to determine what is causing the impingement
Prescribe anti-inflammatory medication such as Ibuprofen or other NSAID’s (non steroidal anti inflammatory drugs).
Advise on rehabilitation programmes to improve function and decrease pain.
Discuss the option of directly injected steroids into the subacromial space to reduce inflammation and reduce inflammation in the local area (this is not usually an early option).
Discuss the option of surgery in cases which have failed conservative rehabilitation efforts – this is usually after a period of at least 6-12 months.