Shoulder impingement

What it is?

One of the most common things we hear from our new patients when they are dealing with shoulder pain is, “My doctor said I injured my rotatory cup (rotator cuff).” This diagnosis can be confusing and also frustrating without knowing how it can happen. So we wanted to discuss one of the most common medical diagnoses for shoulders and potential rotator cuff injury: a shoulder impingement. 

Your shoulder complex is more complicated than what you may think. There’s a significant interaction between what happens at your shoulder, shoulder blade, your upper back, and even your neck. Whenever one of these regions is experiencing a movement dysfunction, it can close down on the space where a tendon of the rotator cuff sits. The connective tissues of the rotator cuff musculature (tendons) basically cover the top portion of your arm and anchor the shoulder to the shoulder blade. These tendons can take compression up to a certain point. However, once this threshold is met, and there’s more friction than what this connective tissue can handle, things start to break down.

Imagine a cheese grater on your muscle. With every movement that compresses the involved tendon it can literally start to fray the tissue over time. This doesn’t sound great and it doesn’t feel great either. 

We see these types of injuries across all age groups. It’s extremely common to see a young athlete who can’t throw a ball anymore because of a sharp, pinching sensation whenever they get their arm elevated. It’s probably even more common to see someone who has been working in an office for years having similar symptoms. It all comes down to why the pressure is being increased in that area, and on that tendon. We seem to be seeing more of this, which is as if these injuries are happening due to the frequent use of daily technologies and what that does to our body’s positioning.

What do the symptoms look like? I put together a list of a few things you may be experiencing with shoulder impingement or rotator cuff injuries in general. 

Early Stage

• Pain in the front or side of the shoulder
• Pain with movement of the shoulder (lifting, reaching, or lowering)
• Soreness or ache at rest
• Athletes: Pain with throwing or their sport specific activity

Late Stage

• Pain at night
• See Early Stage

Why is it important that you address the symptoms?

 Your rotator cuff is responsible for maintaining the position of the shoulder itself. Without the stability of the rotator cuff it can be extremely difficult to do something as simple as lifting your arm in front of you. If you let the slight, intermittent nagging sensation develop over time, it can result in serious pathology of the tendon or other tissue in the area.  

There have been multiple instances where I have had a patient tell me that they have bursitis in their shoulder. This can also be an indicator of an actual impingement at the shoulder complex. Both of these diagnoses may be caused by the same exact movement dysfunction that is taking place. As physical therapists we specialize in identifying the actual movement dysfunction that is acting as the cause of these symptoms.

As far as imaging goes, X rays will typically show a bony change of some sort. This will typically be reported as a bone spur. MRIs are actually the preferred imaging to diagnose a true rotator cuff injury. If there is no significant pathology identified by the physician reading the image, then a typical diagnosis is shoulder impingement syndrome. This is based on my clinical perspective after treating multiple cases that are originally diagnosed as rotator cuff injuries.

Why Is It So Common?

It’s generally understood in the younger population that overhead athletes are at more risk of shoulder impingement and rotator cuff injury. This includes throwers, swimmers, and tennis players. The volume that these young athletes have to endure is immense and the tissue can breakdown with positional changes throughout the shoulder or scapular region. 

From an occupation standpoint. Manual laborers such as painters and construction workers can be vulnerable for a similar reason as a young athlete. The volume may not be as significant, but the load or the amount of time they have to maintain an overhead position can be just as strenuous on the shoulder joint. However, one of the more common things we see is for office workers to have an impingement diagnosis with or without significant rotator cuff trauma. So why is that? 

One of my first ever shoulder patients was a mom who worked an office gig. She told me she worked significantly long hours, took care of the kids, and tried to stay active with various fitness activities when her time allowed. After sitting at a computer for 8-10 hours a day she would have to pick up her young kids, take them to practices, and then try to work out late at night or incredibly early in the morning. One day after work she was getting her kids loaded up, she reached into the back seat from the front seat to lift something and she felt a pop. She had experienced a rotator cuff tear after chronically ignoring minor aches and pains due to her demanding schedule. What likely happened was that she was experiencing what we refer to as shoulder impingement and was wearing her tendons down over time until one gave up. The office lifestyle is actually very tough for shoulder injuries because you spend multiple hours sitting in front of a computer working and the last thing on our minds is proper posture. After the muscles are super stiff from this poor positioning, we try to do other things which cause our movements to become more dysfunctional. It’s essentially a vicious cycle until a certain muscle/tendon can’t keep up with the demand.

How Do We Treat It?

The first priority is knowing why this happened. Once you know the true cause of the symptoms you can work more efficiently to calm down these symptoms. We have to take a look at several regions of the body to figure out what is playing a significant role in your pain. 

After this we can implement several specific manual techniques (some of which can even be done at home) that best suit your presentation. This can be relative to improving joint mobility or any soft tissue restrictions present in the area. 

The progression of movement is the long term key to prevention of another injury and initially taking the pressure off of the involved tendon. We use specific corrective movements to address any faulty movement patterns that we see. 

Please don’t wait too long! If you suspect that you may be experiencing minor pain from a shoulder impingement issue then set up a FREE 15 min screen with us. So if you have any questions or think we can help you out give us a call, our number is (817) 923-9000. We’ll do everything we can to get you back on track and hopefully prevent anything significant happening because of it!