Shoulder impingement is a condition characterized by pinching or compression of soft tissues, such as the rotator cuff tendons and/or the subacromial bursa, between top of the ball and he bottom of the socket of the shoulder joint during certain movements of the shoulder
Normally the rotator cuff muscles and the scapular (shoulder blade) muscles work in harmony to ensure there is adequate room for the the rotator cuff tendons and the bursa whilst the arm is lifted out to the side and above the head. Impingement often occurs if there is any dysfunction in these muscles causing poor control of the movement.
Occasionally due to injury associated with overuse or a specific incident, the rotator cuff tendons or subacromial bursa may become damaged, swollen and inflamed. As a result of the swelling, the rotator cuff tendons or subacromial bursa may occupy more space and can subsequently become compressed or pinched with shoulder movement.
Several other postural, biomechanical or anatomical anomalies can also cause impingement. In some people the shape of their acromion (see picture) predisposes them to this condition.
Patients with shoulder impingement typically experience pain at the top, front, back or outer aspect of the shoulder. Pain may also radiate into the upper arm as far as the elbow. The pain is usually along the lateral/outside of the arm and can also be down the front of the biceps muscle.
Patients with this condition often heal well with appropriate physiotherapy and return to normal function in a number of weeks. Occasionally, rehabilitation can take significantly longer and may take months. In some cases a cortisone injection can be very beneficial combined with appropriate rahbilitation. Early physiotherapy treatment is vital to hasten recovery in all patients with shoulder impingement.
Treatment for Shoulder impingement / Sub-acromial bursitis
Physiotherapy treatment for patients with this condition is vital to hasten the healing process, ensure an optimal outcome and decrease the likelihood of injury recurrence. Treatment may comprise:
- Bimechanical Assessment (Scapular rhythm)
- Deep tissue massage / myofascial release
- Dry needling / acupuncture
- Dry needling /acupuncture
- Activity modification advice
- Exercise programs to improve proprioception, strength (rotator cuff and scapular) and posture
- Ice or heat treatment
- Joint mobilisation
- Joint manipulation
- Injection advice