Shoulder Impingement

What is a Shoulder Impingement?

One of the most typical physical complaints is shoulder pain. Your shoulder comprises several joints connected with tendons and muscles that allow a great range of movement in your arm. Because so many structures make up the shoulder, it is weak to many problems. The rotator cuff is a recurring origin of pain in the shoulder.

Shoulder impingement is a common condition that causes pain and inflammation in the shoulder joint. It occurs when the tendons of the rotator cuff muscles become compressed or pinched between the bones of the shoulder joint.

One of the most typical causes of shoulder discomfort is impingement. It is largely unspecific and appears gradually, implying that it occurs regardless of any trauma. Subacromial pain syndrome is the correct terminology for the condition.

A mix of strengthening, stretching, and mobility exercises is frequently suggested to reduce the pain and improve shoulder function associated with shoulder impingement.

This article will include some of the finest exercises for managing shoulder impingement and promoting recovery. Some treatments involve rest, ice, anti-inflammatory medicines, physical therapy, cortisone injections, and surgery.

Introduction

Shoulder impingement syndrome is a frequent condition that affects athletes and anyone who engages in a lot of overhead arm movements.

Shoulder impingement syndrome is caused by a vicious cycle of the rotator cuff pressing on the humerus and the upper outer border of your shoulder. Rubbing causes further swelling and narrowing of the area, resulting in discomfort and irritation.

Shoulder impingement is a comprehensive phrase that refers to the irritation or damage of the shoulder and subacromial spaces. Some models include but are not confined to, rotator cuff tendinosis (irritation of the muscle-to-bone connection), rotator cuff tears (partial or complete tear of the muscle-to-bone connection), and bursitis (inflammation of the liquid-filled sacs that surround the shoulder).

Shoulder impingement may be referred to by a variety of terminology, including:

• Impingement syndrome of the shoulder
• Rotator cuff tendonitis
• Swimmer’s shoulder

Subacromial discomfort is typically caused by a tissue overload, which means tension that the shoulder was not built to endure. Picking up a 10-pound weight, getting a cramp in your shoulder area, and then feeling a severe pinching sensation in the shoulder as you lift your arm could indicate it. It is common in young athletes who bench press with heavier weights without first building up their shoulder strength.

Anatomy of Shoulder

Your shoulder is composed of three bones: the upper arm bone (humerus), the shoulder blade (scapula), and the collarbone (clavicle).

Your arm is preserved in the shoulder socket by the rotator cuff. These muscles and tendons form a covering around the head of the upper arm bone and link it to the shoulder blade.

A lubricating pouch called a bursa exists between the rotator cuff and the bone on top of your shoulder (acromion). When you drive your arm, the bursa allows the rotator cuff tendons to glide voluntarily.

What Are the Most Common Causes of Shoulder Impingement?

The rotator cuff is frequently the root of shoulder discomfort. Pain can be caused by:

• Tendinitis. Rotator cuff tendons can become inflamed or injured.
• Bursitis. The bursa can become inflamed and swollen, producing discomfort.
• Impingement. The gap between the acromion and the rotator cuff narrows as you elevate your arm to shoulder height. The acromion can cause discomfort and pain by rubbing against (or impinging on) the tendon and bursa.

Other postural causes of Impingement:

• Bad posture.
• Excessive use of the shoulder.
• Changes in shoulder motion sequences may be related to inequality, weakening, or tightness of the muscles involved in shoulder movement.
• Repetitive overhead moves like golf, throwing a ball, tennis, swimming, or constantly reaching or lifting above.
• A significant shoulder injury (or trauma).
• Degeneration of the shoulder joints results in the production of osteophytes, which are bone pieces that limit the space.
• Acromion skeletal abnormalities that cause a reduction in subacromial space.

The Signs and Symptoms of shoulder impingement?

• A general sensation of stiffness and throbbing in the shoulder. Swelling in the shoulder may also be observed or sensed.
• Difficulty lifting the arm above shoulder level.
• It will also have to work hard to reach the arm behind the back.
• The shoulder will normally hurt and be stiff when resting and will be more harmed when the individual makes use of it.
• It may become more dangerous over time, with pain increasing and strength decreasing.
• Rest on the involved side of their body.
• Putting the arm behind the back may become hard.
• Radiating pain spreads from the front of the shoulder to the side of the arm.

The symptoms worsen as the condition progresses:

• Pain at night
• Loss of strength and mobility
• Difficulty doing actions that need the arm to be placed behind the back, such as buttoning or zipping garments.
• If the pain occurs unexpectedly, the shoulder may become extremely tender. Every movement may be restricted and painful.

Diagnosis for shoulder impingement

Medical History and Physical Examination

The physician will check your shoulder after examining your symptoms and medical history. They will examine to see if there is any tenderness or if there is an abnormality. The physician will have you move your arm in various directions to determine the range of motion of your shoulder. They will also put your arm strength to the test.

Diagnostic test

• The Painful Arc Test: Raise your affected arm out to the side and above your head, as if doing a jumping jack with one arm. If you feel discomfort in your shoulder when raising your arm to the midline or higher, you may have a shoulder impingement.
• The Hawkins-Kennedy Test: Cross the affected arm over your body, relaxing your hand on the other shoulder. Your elbow will be around 90 degrees flexed. Raise your elbow as much as you can without allowing your hand to fall off your shoulder. If you have pain at the lowest range of motion of your shoulder, you may have a shoulder impingement.
• The Neer Test: Raise your arm straight in front of you to 90 degrees and point your thumb towards the ground. Raise your arm above while keeping your thumb down. Pain in the shoulder towards the peak of the motion may indicate a shoulder impingement.

The physician will examine your shoulder joint for any additional issues. They may also do a neck examination to ensure that the discomfort is not caused by a pinched nerve and to rule out other disorders such as arthritis.

Imagine test

X-rays: Because X-rays do not detect soft tissues like the rotator cuff, simple X-rays of a shoulder with rotator cuff discomfort usually appear normal or may show a minor bone spur. An outlet view, a kind of X-ray, may occasionally reveal a tiny bone spur on the front border of the acromion.

Magnetic resonance imaging (MRI) and ultrasound: MRI scans can produce more accurate pictures of soft tissues, such as the rotator cuff tendons, than X-rays. Fluid or inflammation in the bursa and rotator cuff might be seen. In some situations, rotator cuff tears might be visible.

How to Relieve Shoulder Impingement Pain

follow the treatment plan to relieve Shoulder Impingement Pain:

Non-surgical Treatment for shoulder impingement

• Rest and Icing: The physician may advise you to relax and modify your activities, such as avoiding overhead activities. Ice can be used in the form of a cold pack, an ice pack, or an ice cup massage. Ice is used to reduce inflammation in the affected region.
• NSAIDs (nonsteroidal anti-inflammatory medicines): Pain and swelling are reduced by medications such as ibuprofen, aspirin, and naproxen.
• Physical Therapy: A physical therapist will first work on regaining normal shoulder mobility. Stretching activities to increase the range of motion are beneficial. If you have difficulties reaching behind your back, you may have stiffness in your shoulder’s posterior capsule (capsule refers to the inner lining of the shoulder and posterior refers to the rear of the shoulder). Stretching the posterior capsule can be quite beneficial in reducing shoulder discomfort. Once the pain has decreased, your therapist could start you on a rotator cuff strengthening program.
• Injection of steroids: If rest, drugs, and physical therapy do not reduce your discomfort, a local anesthetic and cortisone injection may be beneficial. Cortisone is a powerful anti-inflammatory medication. It can be insinuated into the bursa under the acromion to relieve pain.

When nonsurgical pain relief doesn’t work, the physician may prescribe surgery.

Surgical Treatment for shoulder impingement

• The purpose of surgery is to make extra room for the rotator cuff. To accomplish this, the physician will remove the swollen bursa. They may also cut away a portion of the acromion. 
• Subacromial decompression is another term for this. These treatments are often performed using an arthroscopic approach.

Exercise to relieve signs of shoulder impingement

1. Isometric Shoulder Internal and External Rotation

Isometric Shoulder Internal Rotation

By strengthening the tendons and muscles that surround the shoulder joint, this exercise raises the maximum weight that your shoulder can support. This may be useful if you have a shoulder injury or other issue that makes movement unpleasant.

Use these steps to perform an isometric shoulder internal rotation:

• Place your side against a door or wall frame.
• Put your forearm up against the wall or door frame and flex your elbow to a ninety-degree angle.
• As though attempting to turn your shoulder inside, press your forearm against the wall or door frame.
• Hold for 5 to 10 seconds.
• Relax
• Do this ten to fifteen times.

Isometric Shoulder External Rotation

To do an isometric shoulder external rotation, follow these steps:

• Place your side against a door or wall frame.
• With your palm facing away from you, rest your forearm on the wall or door frame and bend your elbow to a 90-degree angle.
• As though attempting to move your shoulder outward, press your forearm into the wall or door frame.
• Hold for 5 to 10 seconds
• Relax
• Do this ten to fifteen times.

2. Side-Lying Shoulder External Rotation

The external rotator muscles of the shoulder can be strengthened by performing side-lying shoulder external rotation exercises. These muscles are necessary for overhead motions and for stabilizing the shoulder joint.

• Place a cushion beneath your head for support as you lie on your side.
• Place your forearm on a towel roll or other soft item and bend your upper arm to a 90-degree angle.
• Grip a lightweight object in both hands, like a water bottle or dumbbell.
• Lift the weight towards the sky by slowly rotating your forearm outward while maintaining a bent elbow.
• Remove the weight and return to the initial position.
• After ten to twelve repetitions, change sides.

3. Shoulder Scaption

Shoulder scaption exercises are an excellent method to increase shoulder strength and range of motion. They can also aid in lowering shoulder impingement-related discomfort and inflammation.

Standing Shoulder Scaption

• As you stand, place your feet about the width of your shoulders and your arms at your sides.
• Raise your arms gently up and out to the sides until they are parallel to the floor, keeping your elbows straight.
• Return your arms to their starting positions gently after a brief moment of holding.
• Do this ten to fifteen times.

Prone shoulder scaption

• Lie on your belly with your hands facing down and your arms by your sides.
• Raise your arms gently up and out to the sides until they are parallel to the floor, keeping your elbows straight.
• Return your arms to their starting position gently after a brief time of holding.
• Do this ten to fifteen times.
• These exercises can be done with light weights or without weights. Stop the workout and seek medical advice if you feel any pain.

4. The Shoulder blade squeezes

Squeezing your shoulder blades is a simple yet efficient workout that strengthens your upper back and enhances shoulder stability. This may help reduce the soreness and swelling brought on by shoulder impingement.

The steps for performing shoulder blade squeezes are as follows:

• With your arms by your sides, place your feet about the width of the shoulder apart.
• As if you were attempting to squeeze a piece of paper between your shoulder blades, gently bring them together and back.
• Hold for a short while, then let go of your shoulders.
• Do this ten or twelve times.
• Squeezing your shoulder blades while sitting or lying down is another option.

5. Crossover arm stretch

The crossing arm stretch is a simple and effective way to expand the shoulder range of motion and relieve shoulder impingement pain. It can help to decompress the subacromial region, where the rotator cuff tendons move, as well as stretch the muscles in the chest, shoulder, and upper back.

The crossover arm stretch is performed in the following method:

• Place your feet approximately shoulder-width apart, arms by your sides.
• Cross your right arm over your body with your right hand resting on your left elbow.
• Pull your left elbow across your body gently until your right shoulder and chest stretch.
• After 30 seconds of holding, release.
• Continue on the other side.
• You can perform this two to three stretches per day.

6.The doorway stretch(chest stretch)

The doorway stretch, also known as the chest stretch, is a gentle and efficient approach to enhance the shoulder range of motion and relieve discomfort caused by impingement. It stretches the muscles in the chest, shoulder, and upper back, as well as helps to decompress the subacromial region through which the rotator cuff tendons pass.

Following are the steps for performing the doorway stretch:

• Stand in a doorway with your arms at your flanks in walk standing position.
• Place your right hand at shoulder height on the doorframe, with your elbow bent at a 90-degree angle.
• Step forward with your left foot through the doorway, maintaining your hips square.
• Lean forward and twist your left shoulder away from the doorframe until your right chest stretches.
• grasp for 30 seconds before relaxing.
• Reverse the process on the other side.
• This stretch may be done 2-3 times each day.

7. Wall angels

Wall-angel is an incredible exercise for improving shoulder posture and alleviating shoulder impingement discomfort. They assist in strengthening the muscles surrounding the shoulder joint, which helps to stabilize the joint and lowers the chance of impingement.

Here are the steps for making wall angels:

• Stand tall with your back to a wall and your feet shoulder-width apart.
• Place your hands at shoulder height on the wall, fingers pointing front.
• The back and head should be forced against the wall.
• Raise your arms slowly upward, elbows straight, and hands softly contacting the wall.
• Hold for 5-10 seconds before lowering your arms back to the beginning position.
• Repeat 10-15 times more.

8. resistance band pulls

Resistance band pulls function to strengthen the rotator cuff. This can assist in improving shoulder stability and lowering the risk of additional damage.

Following are the procedures for performing resistance band pulls.

• Begin by standing against the wall, hands up, elbows bent at the sides, and clutching the resistance band.
• To separate the band, twist the shoulders externally while pressing the shoulder blades together.
• Maintain a tight grip on your forearms; there shouldn’t be much gap between your torso and your elbow.
• Three sets of 10 repetitions should be your goal.

9. Floor Cobra Raises

By strengthening your middle and lower trapezius muscles, this exercise can help you improve your posture.

Following are the procedures for performing floor Cobra Raises

• With your hands pointing toward the floor, lie on your back.
• Raise your arms off the floor by gently rotating them from the outside.
• Press your shoulder blades together for one to two seconds.
• Complete three sets of 10 repetitions.

10. Thoracic extension exercises

Thoracic extension exercises are an important component of a shoulder impingement treatment strategy. They can aid in the improvement of shoulder mobility and reduce the feeling of discomfort.

Here are the steps for doing Thoracic extension exercises

• lying on your back with your knees bent and your feet flat on the base.
• Place the foam roller over your upper back, just behind your shoulder blades.
• Arms should be at your sides.
• Lift your chest off the floor by gently arching your back over the foam roller.
• maintain for a few moments before slowly lowering back to the original position.
• Repeat 10-15 times more.
• Throughout the activity, take deep breaths.
• If you have any discomfort, stop exercising and talk with your doctor or physical therapist.
• This exercise may be done 2-3 times each day.

Which activities you should avoid with shoulder impingement?

• Stay away from the activities that pain you more.
• Stay away from overhead tasks such as lifting and throwing.
• Stay away from sports like tennis, cricket, and badminton that put stress on your shoulders.
• If you enjoy working out at the gym, spend a few days doing leg exercises instead of upper body workouts.

If you modify the intensity, you may often continue participating in your favorite activities and workouts even if you have a shoulder impingement. It is not worth advising the individual who enjoys swimming to stop since they will either not stop or will get upset. “They simply need to reduce it.”

Choose an alternative activity to keep yourself busy until you are well enough to try the exercise again if you are unable to complete it at any intensity with comfort. By doing this, you may rest your shoulder and maintain your strength, general activity level, and mobility.

Summary

Shoulder impingement is usually caused by overuse of the shoulder. Swimmers, baseball players, and other sportsmen may be particularly vulnerable to this injury. People who work in jobs that require a lot of lifting may also be more prone to shoulder impingement.

Preventing shoulder impingement by learning how to properly elevate and move the shoulder may be the most effective way to avoid damage. Most people respond favorably to modest therapies like rest and physical therapy. NSAIDs are also effective with pain and inflammation relief. Anyone unsure about their symptoms or treatment choices should consult a doctor.

FAQs

References

• Professional, C. C. M. (n.d.-e). Shoulder impingement Syndrome. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/7079-shoulder-impingement-syndrome
• Shoulder Impingement/Rotator cuff tendinitis – OrthoInfo – AAOS. (n.d.). https://orthoinfo.aaos.org/en/diseases–conditions/shoulder-impingementrotator-cuff-tendinitis
• Hersh, E. (2018, September 29). Shoulder impingement. Healthline. https://www.healthline.com/health/shoulder-impingement
• Farotech. (2023, October 21). 9 Shoulder impingement exercises to relieve pain. EmergeOrtho. https://emergeortho.com/news/shoulder-impingement-exercises/