Shoulder Impingement Syndrome: Symptoms and Treatment
Our very own Brian Kelly, DPT, ATC, SCS, COMT, was recently featured by U.S. News & World Report, read on below!
Shoulder impingement is a common cause of shoulder pain, and it can limit your ability to do certain activities.
Shoulder impingement is what happens when the top outer edge of your shoulder blade, called the acromion, rubs against or pinches the rotator cuff that’s under it. The rotator cuff is a group of tendons and four muscles that come together and form a covering around the upper arm bone called the humerus. Impingement is a common way to describe that painful pinching or rubbing.
Other names for shoulder impingement include rotator cuff tendinitis and shoulder impingement syndrome.
Symptoms of Shoulder Impingement Syndrome
Shoulder impingement has several symptoms:
- Pain in the front and side of the shoulder. The pain gets worse during or after strenuous or repetitive lifting activities with the arm outstretched or overhead, says Dr. Robert M. Orfaly, a professor in the department of orthopedics and rehabilitation at Oregon Health and Science University in Portland. Orfaly specializes in shoulder, elbow and hand surgery.
- Pain when trying to reach across your body or behind your back.
- Pain when trying to sleep on the affected side.
- Tightness in the shoulder and/or the outside of the upper arm.
- Weakness in the affected shoulder and arm as your symptoms get worse.
The pain from shoulder impingement may start as a dull ache but become sharper over time, says physical therapist Paul Schroeder, a spokesperson for the American Physical Therapy Association and founder and owner of Fast Track Physio in Chicago. There could be times when you move your arm and shoulder a certain way and you feel a sharp pain.
If you’re an athlete, you may notice the symptoms during any overhead activity, like when throwing a ball or when serving in tennis, Orfaly says.
Shoulder Impingement Causes and Risk Factors
Some causes of shoulder impingement include:
There are times when shoulder impingement has no apparent cause. Impingement can affect both younger people, particularly athletes, as well as adults.
You’re also more at risk for shoulder impingement if you:
- Are an athlete who does sports that include a lot of overhead activities. Schroeder says this can include activities like baseball, softball, swimming, tennis and volleyball.
- Make repeated overhead arm movements in your job, such as in manual labor or heavy lifting.
Diagnosing Shoulder Impingement
Although you can start by seeing a primary care provider for any persistent shoulder pain, you may get referred to an orthopedic specialist. A physical therapist also may be involved in diagnosing your shoulder impingement.
During an exam, the provider will discuss your medical history and symptoms. The provider also will measure your shoulder strength and range of motion by having you move your affected arm around.
To help pinpoint the diagnosis of shoulder impingement, you may need an X-ray. Although an X-ray isn’t used to diagnose impingement, it could help rule out certain other shoulder problems, like arthritis or bone spurs.
Additionally, your provider may order an MRI to diagnose shoulder impingement. Imaging techniques like MRIs do a better job than X-rays of visualizing soft tissues, such as rotator cuff tendons. An MRI can show inflammation in the bursa, which is a fluid-filled area between the rotator cuff tendons and acromion. It also can show rotator cuff tears, Orfaly says.
The provider will use your pain complaints, physical exam findings and imaging to confirm a diagnosis.
Shoulder Impingement Treatment
Treatment for shoulder impingement aims to help you regain mobility and ease your pain. In the majority of people with shoulder impingement, surgery is not needed.
You’ll likely get better gradually from treatment, but it takes some patience. Sometimes, recovery is as long as 18 months, Schroeder says. However, you should start to notice some improvement with treatment in just a couple of weeks.
Here are some treatments recommended for shoulder impingement:
Specifically, you’ll want to avoid activities like lifting overhead that can irritate your shoulder. Rest doesn’t mean you can’t do any physical activities during your recovery. Speak to your doctor or physical therapist about the activities you can and can’t do.
Ice or heat
Your doctor or physical therapist can advise you regarding the use of ice (like an ice pack) and heat (like a heating pad, hot shower or sauna). Both can relieve pain, but you may find your provider prefers one treatment over the other. If possible, use ice or heat on the affected shoulder a couple of times each day.
Nonsteroidal anti-inflammatory medications
Pain relivers like like ibuprofen or naproxen can help with pain and swelling. Follow any directions from your doctor or on the package regarding the right dosage. It’s also OK to use over-the-counter topical gels that can help relieve pain.
Physical therapy is a major part of recovery from shoulder impingement. Physical therapists can help identify issues leading to your pain, provide treatment and get you returning to your daily activities without pain, says Brian Kelly, a physical therapist with ProRehab, with locations in Illinois, Indiana and Kentucky. It also can help speed up your recovery. Physical therapists usually will give you home exercises so you can continue your recovery between sessions.
Massages can help relieve tension and aid the shoulder in moving again. There also are self-massage techniques for shoulder impingement, as well as self-myofascial release. With self-myofascial release, you can use a foam roller, lacrosse ball or massage gun to target painful areas in your shoulder and help find relief, Schroeder says. Self-myofascial release is a popular way to use self-massage and relieve tight muscles.
To help control pain and inflammation, a provider may inject a steroid medicine called cortisone into the shoulder. A provider may use this if other treatments aren’t working, says Dr. Ronald A. Navarro, director of clinical affairs and professor of orthopaedic surgery with the Department of Clinical Science at the Kaiser Permanente Bernard J. Tyson School of Medicine in Pasadena, California.
Shoulder impingement occasionally requires surgery. This becomes more common if there is a full rotator cuff tear. Surgery will help make space for the rotator cuff by removing the inflamed part of the bursa. Fewer than 20% of patients with shoulder impingement require surgery, Navarro says.
Physical Therapy and Exercises for Shoulder Impingement
Many health insurance plans cover physical therapy. If you have health insurance, check with your provider so you know what coverage is available.
If cost is a concern with covering physical therapy for shoulder impingement, let the physical therapy practice know. Practices often will work with you on a treatment plan that fits your budget, Kelly says. Ask what the self-pay rate is for sessions.
If you can’t make it to physical therapy a couple of times a week due to cost or time limitations, make sure to do your assigned home exercises at least once a day. Even just one or two sessions with a physical therapist can get you on the right path to recovering from shoulder impingement. During that session, the therapist can help educate you and demonstrate good home exercises for you.
Here are two shoulder impingement exercises you can do at home:
Bend forward at your hips. Hang down the affected arm freely. Move your back foot and front foot in a rocking motion. Move your affected arm in a circle clockwise and then counterclockwise for a minute. Repeat as needed to help with pain.
Stand and place your arms at your side with your thumbs facing out. Squeeze your shoulder blades together, and move your arms forward and slightly to the side. Stop moving when your arms reach shoulder level or just before you feel pain. Repeat 10 to 20 times, twice daily.
Lifestyle Tips for Managing Shoulder Impingement
Avoid heavy lifting during your recovery.
Even something like a milk gallon can irritate your impingement. Talk with your provider or physical therapist about any limitations you should keep in mind when lifting things.
Avoid activities that require frequent reaching overhead or behind the back.
Don’t push through your pain.
Stop if you feel a certain movement is painful as that can lead to problems elsewhere in the body. “If it is painful to raise your arm, you will tend to shrug your shoulder. This can lead to neck pain and stiffness,” Kelly shares as one example of why pushing through pain during impingement recovery is a bad idea.
Work on your posture.
Bad posture can kick in when we’re on our phones, using a computer, driving or working, Kelly says. Over time, bad posture can lead to weakness in certain parts of the body. That could include your shoulders. A physical therapist can help you become more aware of your posture so you can actively correct it,” Navarro says.