Shoulder Impingement

Shoulder Impingement, also known as subacromial impingement syndrome, is a common condition that occurs when the tendons or bursa (small fluid-filled sacs) in the shoulder joint become compressed or irritated. This can cause pain and inflammation, as well as limited mobility and weakness in the affected arm.

Shoulder impingement can be caused by a number of factors, a few of which are mentioned below:

• Repetitive overhead activities: Repeated overhead activities such as throwing, swimming, or lifting weights can put a lot of stress on the shoulder joint, which can lead to impingement.
• Poor posture: Poor posture can cause the shoulder joint to be in an awkward position, which can increase the likelihood of impingement.
• Shoulder instability: If the muscles and ligaments that support the shoulder joint are weak or damaged, the joint can become unstable, which can lead to impingement.
• Bone spurs: Bone spurs, which are bony growths that can develop on the bones of the shoulder joint, can also cause impingement.

Symptoms of shoulder impingement can depend on the severity of the condition. Though some are given below:

• Pain in the shoulder joint, particularly when lifting the arm overhead or reaching behind the back.
• Weakness or limited range of motion in the affected arm.
• Swelling or inflammation around the shoulder joint.
• A clicking or popping sensation in the shoulder joint.

Pathology:
Shoulder impingement occurs when the tendons or bursa in the shoulder joint become compressed or irritated, which can cause pain, inflammation, and limited mobility in the affected arm. This compression can occur due to a variety of factors, including repetitive overhead activities, poor posture, shoulder instability, and bone spurs.

Physical Examination:
The therapist will perform a physical examination of the shoulder joint to check for pain, weakness, and limited range of motion. He/she may also move the arm in various positions to assess the impingement.

X-ray:
An X-ray can help detect any bone abnormalities or spurs that may be contributing to the impingement.

Magnetic resonance imaging (MRI):
An MRI can provide detailed images of the soft tissue structures in the shoulder joint, including the tendons and bursa, to help diagnose impingement.

Ultrasound Therapy:
Ultrasound therapy can provide real-time images of the shoulder joint and can be used to detect any inflammation or damage to the tendons or bursa.

Injection test:
A doctor may inject a local anesthetic or anti-inflammatory medication into the affected area to determine if it provides pain relief, which can help confirm a diagnosis of impingement.

Medication: Corticosteroid injections, Nonsteroidal anti-inflammatory drugs (NSAIDs), Acetaminophen, etc.
Note: Medication should not be taken without a doctor’s prescription.

Surgery:
Surgery for shoulder impingement is typically considered a last resort when non-surgical treatments have not been successful in relieving symptoms. Surgery may also be recommended if there is a structural problem with the shoulder, such as a bone spur or a torn rotator cuff, that is causing the impingement.
The two main types of surgery for shoulder impingement are:

• Arthroscopic surgery: This is a minimally invasive procedure in which a small camera and surgical tools are inserted through small incisions in the shoulder to remove any bone spurs or inflamed tissue that may be causing the impingement. Arthroscopic surgery is typically performed on an outpatient basis and has a shorter recovery time than open surgery.
• Open surgery: This involves making a larger incision in the shoulder to access the affected area and remove any bone spurs or inflamed tissue. Open surgery may be necessary if the impingement is severe or if there are additional structural problems that need to be addressed. Recovery time for open surgery is typically longer than for arthroscopic surgery.

Cryotherapy:
Cryotherapy, which involves the application of cold therapy, can be an effective treatment for reducing pain and inflammation associated with shoulder impingement. Cold therapy can help numb the affected area, constrict blood vessels, and reduce swelling, which can in turn help reduce pain and inflammation.

Thermotherapy:
Thermotherapy, which involves the application of heat therapy, can also be an effective treatment for shoulder impingement. Heat therapy can help increase blood flow, relax muscles, and reduce pain and stiffness associated with shoulder impingement.

Transcutaneous electrical nerve stimulation (TENS):
TENS uses electrical impulses to stimulate the nerves in the affected area, which can help reduce pain and promote healing.

Ultrasound therapy:
Ultrasound therapy uses high-frequency sound waves to promote tissue healing and reduce inflammation in the affected shoulder joint.

Electrical muscle stimulation (EMS):
EMS uses electrical impulses to stimulate the muscles in the affected shoulder joint, which can help improve strength and reduce pain.

Interferential current therapy (IFC):
IFC uses electrical impulses to stimulate the nerves in the affected area, which can help reduce pain and improve circulation.

Cold laser therapy:
Cold laser therapy uses low-level laser light to promote tissue healing and reduce inflammation in the affected shoulder joint.

Range of motion exercises:
These exercises can help improve flexibility and mobility in the shoulder joint.

Strengthening exercises:
Strengthening exercises can help improve the strength of the muscles that support the shoulder joint, which can help reduce impingement.

Manual therapy:
Manual therapy techniques, such as massage or joint mobilization, can help reduce pain and stiffness in the affected shoulder joint.

Posture correction:
Poor posture can contribute to shoulder impingement, so a physiotherapist can work with the individual to correct any postural imbalances that may be contributing to the condition.

Activity modification:
The physiotherapist may recommend modifying or avoiding certain activities that may exacerbate the impingement.

The physiotherapist should emphasize the importance of following up and attending scheduled physiotherapy appointments to monitor progress and adjust treatment as needed. Overall, patient education is important to help patients take an active role in their treatment and recovery and improve their quality of life with shoulder impingement.