Shoulder Impingement

The shoulder is such a complex joint, that when somebody has shoulder joint pain the etiology of that pain can be vast. Most patients that come to me with shoulder pain have “Googled Diagnosed” and are certain that the neck is the culprit of their condition.  Some have correctly assumed that the cervical spine has referred the pain to their shoulder, but more times than not a very common clinical condition known as “Shoulder Impingement Syndrome” is the cause. Repeated overhead activity, such as painting, lifting, swimming, surfing, and tennis are risk factors for this. The good news is that 90 percent of shoulder impingement syndromes can be managed conservatively.

The mechanism of injury can be broken up into four different factors:

• First, an area of vascular insufficiency termed “the critical zone” is right where the supraspinatus (one of four rotator cuff muscles) attaches to the humerus.  The biceps tendon can also be influenced by vascular factors because of its anatomical relationship.  These structures are subject to compression upon arm elevation.
• Second, aging or degenerative from multiple tendon tension overloads, result in calcification and erosion of these tendons.
• Third, traumatic which involves ruptures of the rotator cuff are usually associated with dislocations and fractures of the humerus.  Ruptures tend to happen in the younger athletes and are associated with a specific violent injury.
• Finally, the most common cause is mechanical anatomic factors.  Impingement of the supraspinatus and biceps can occur against the head of the humerus and coracoid process of the scapula. 

Patients can have a crunching sound with shoulder movement which typically is seen with calcific tendinitis.  Athletes will complain of poorly localized deep ache pain in the shoulder following overhead activity.  The “Classic Sign” is pain at night that radiates down the outside of the arm.  Usually from laying on it. 

I like to break up treatment into four phases:

• Phase one focuses on getting inflammation down, relative rest, and activity modification.
• Phase two involves strengthening and flexibility of the muscles, such as the supraspinatus and biceps.
• Phase three steps it up a little bit with dynamic strengthening based on high rep/ low resistant exercises.
• Phase four is return to normal activity.

The medical approach is oral anti-inflammatory medications such as aspirin, naproxen, or ibuprofen.  These medications are usually given six to eight weeks, but precaution should be given as side effects like upset stomach, indigestion, and headaches could occur.  If symptoms persist then a medical doctor may consider a cortisone- type injection. Overuse of this type of treatment may result in weakening of the muscles and tendons.

To yours in better health!