THE SHOULDER JOINT
The shoulder is an important joint which is integral to our everyday function. Many of our everyday tasks involve reaching, grabbing, pulling, and pushing. So when we injure it, many of our daily activities are affected, like putting out the laundry, getting dressed, etc.
The shoulder joint (or joints) have a lot of movement, and yet, this is its trade-off – it's less stable. It is made up of your humerus (your upper arm bone), your shoulder-blade/scapula, and a collarbone/clavicle. Concerning impingement, between the humerus and the acromion on the shoulder-blade, there is a small space called the subacromial space. In this space, the rotator cuff muscles run – four muscles which help to stabilise your shoulder when you move your arm.
Shoulder impingement occurs when this space is narrowed, causing the rotator cuff muscles to be compressed and pinched. This can lead to injury to the tendons of these muscles, with inflammation of these and the bursa (a sac full of fluid which helps decrease friction in the joint). Impingement is a common syndrome and is often seen in people who play sports that require repeated overhead movements e.g. tennis, baseball. Jobs that also require overhead lifting or reaching are also more at risk.
Pain is the main symptom and can even extend from the top of the shoulder down to the elbow. It can be produced when lying on your shoulder, or with movement – including putting your hand behind your back/head, and particularly with overhead activities. There may also be weakness when reaching or lifting.
There are three main causes of shoulder impingement:
1. Bony shape – sometimes the shape of your acromion is more curved or hooked, narrowing the space for the tendons. This increased the chance of them becoming pinched as the arm is lifted up.
2. Poor shoulder-blade stability – this occurs particularly with weak or tight muscles surrounding your shoulder-blade. The poor control of your shoulder-blade causes the acromion to move forwards and downwards, narrowing the space for the tendons. Weakness of the rotator cuff muscles themselves causes the humerus move upwards, also compressing the rotator cuff tendons. Poor posture ie. ‘slouching’ can also serve to predispose to impingement due to narrowing of the subacromial space.
3. Repeated overhead activities e.g. sports that involve a lot of overhead throwing, can cause repetitive trauma to the tendons.
Knowing the cause of your shoulder pain is important for both Physiotherapists as well as for you, the patient. It will help ensure that you receive the right treatment.
Physiotherapy can greatly help you with any shoulder pain, including impingement. There are various treatments, including strengthening the rotator cuff muscles and the muscles stabilising your shoulder-blade, stretching, exercises to improve posture and mobility, manual therapy, taping, electrotherapy, and dry needling. When symptoms do not settle with a normal course of Physiotherapy, a surgical opinion may be suggested, but usually is not required.
How long will it take to get better? There is no set time for recovery – it may be a couple of weeks to several months as everyone’s mechanics are individual.
If you have any questions regarding your shoulder pain, or are interested in seeing if we can help you, please give us a call at (02) 8411 2050. Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We have expertise in musculoskeletal physiotherapy and are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.
Escamilla, R. F., Hooks, T. R., & Wilk, K. E. (2014). Optimal management of shoulder impingement syndrome. Open Access Journal of Sports Medicine, 5, 13–24.