Impingement Syndrome is a common cause of pain in the adult shoulder and can occur  in combination with other shoulder pathologies such as bursitis, tendonitis or adhesive capsulitis. To understand impingement  syndrome, it is important to know something about the anatomy of the shoulder.  Anatomically, the shoulder is a large ball in a small socket (somewhat like a golf ball on a tee).  The ball is the head of the humerus which articulates with glenoid socket (the tee) of the scapula/shoulder blade. 

Thanks to the oversized humeral head, the shoulder demonstrates the most motion of all our body's joints . This may seem to be a good thing however, greater joint  mobility requires greater joint  stability. Shoulder joint stability is the primary role of the rotator cuff.  The tendons of four scapular muscles blend together to form a musculo-tendinous cuff (a.k.a. the rotator cuff) around the humeral head (ball) stabilizing it tightly in the tiny socket while also assisting with shoulder movement.  For normal function, each rotator cuff muscle must be healthy, coordinated, conditioned & securely attached via its tendon.

Repeated overhead motion can cause the rotator cuff tendons to rub upon an area of the shoulder blade called the acromion. When this occurs, the rotator cuff becomes inflamed and internally swollen, a condition called rotator cuff tendonitis. Additionally, the shoulder bursa, a fluid filled sac that serves as padding between bone & soft tissue, may become inflamed as well (a.k.a. bursitis).   A swollen rotator cuff or bursa can be repeatedly  pinched or "impinged"  under the acromion with every arm lift creating a vicious cycle of pain and inflammation. Once diagnosed, this impingement syndrome is generally treated with some combination of rest, ice, anti-inflammatory medication, steroid injection and/or physical therapy.  As far as PT goes, treatment should include postural strengthening, scapular stabilization, functional exercise, manual joint mobilization techniques, thermal agents &/or modalities (ie: electric stim, LASER, iontophoresis or ultrasound) as needed. Symptoms typically resolve in 4-6 weeks however, resistant cases may require arthroscopic surgical intervention by the orthopedist.

The common signs of shoulder injury are pain with reaching or lifting movements, loss of shoulder strength or motion, inability to tolerate lying on the affected side and symptoms that worsen progressively with use or over time. When severe, pain may even radiate down the side of the arm and be present both during activity and at rest.  So, what's the take home message here?  Don't push  through recurrent shoulder pain. The earlier you catch shoulder dysfunction the easier it is to fix! 

Submitted by Vicki Schuppe, PT, CHT