Shoulder Impingement Syndrome (SIS) is a common cause of shoulder pain. Patients with this condition experience pain related to the shoulder’s tendons and soft tissues when lifting the arm overhead. The extension of bone at the top outer edge of the scapula is called the acromion. When someone lifts their arms overhead, the space between the acromion and humeral head (top of the upper arm bone) becomes smaller. In this space are also the rotator cuff, biceps tendon, and bursa. Compression (impingement) of these structures causes pain and limits movement. Inflammation of the bursa (also known as bursitis), or of the tendons of the rotator cuff or biceps is painful. Over a period of time, degenerative changes can occur in the tendons. In some circumstances, repeated rotator cuff impingement can cause partial tears in the tendons. These may even lead to larger or complete tears over time. Repetitive arm movements, particularly those performed overhead during certain sports (such as swimming, volleyball, or tennis) can increase the likelihood of developing shoulder impingement syndrome. This pain can also develop as a result of a minor event in which there is impact, such as a fall onto the shoulder or falling onto an outstretched hand. In some rare cases, the problem has no obvious cause.
Causes & Symptoms
The rotator cuff tendon passes through a space below the acromion; the acromion is the bony tip of the outer edge of the scapula that comes off the top of the backside of this bone – it then meets with the end of the collar bone (clavicle) at the shoulder. Shoulder impingement syndrome occurs when the tendon rubs against the acromion. Cause of shoulder impingement syndrome can include the following:
- The tendon is torn or swollen. This may be due to overuse from the repetitive activity of the shoulder, injury, or from age-related wear and tear.
- The bursa is irritated and inflamed. The bursa is the fluid-filled sac between the tendon and the acromion. The bursa can become inflamed due to overuse of the shoulder or injury.
- The acromion is not flat. Typically, this occurs if the patient has developed age-related bone spurs on the acromion.
Other common symptoms of shoulder impingement syndrome include:
- Increased pain when the arms are extended above the head.
- The pain when lifting the arm, or lowering the arm from a raised position, or when reaching.
- Pain that moves from the front of the shoulder to the side of the arm.
- Pain and tenderness in the front of the shoulder.
- Shoulder and / or arm weakness and stiffness.
- Pain when reaching behind the back.
Symptoms normally develop gradually over weeks to months. Shoulder impingement is related to other common sources of pain in the shoulder called bursitis and rotator cuff tendonitis. These conditions can occur alone or in combination. Shoulder pain can also be a sign of a more severe injury to the rotator cuff, which is a small tear or hole called a rotator cuff tear. If the rotator cuff has been torn completely, it is likely to have significant weakness and may not be able to raise the arm against gravity. Additionally, a patient may have a rupture of the biceps muscle tendon as part of the impingement.
Who Gets Shoulder Impingement Syndrome?
As with so many conditions, you are more likely to suffer from a shoulder impingement as you get older (equally to both men and women). Even if you stay active, your tissues lose volume and capability as you age. Previous shoulder injuries also increase your risk.
Shoulder impingement syndrome is also known as a swimmer’s shoulder because it affects those people who regularly engage in sports, like swimming, or jobs such as painting, that require repeated overhead motions.
Other activities that place you at an increased risk of developing a shoulder impingement include:
- Golf
- Tennis
- Basketball
- Fishing and casting
- Weightlifting
- Baseball, football, and other sports that involve overhand throwing
Additionally, certain types of arthritis can bring on a shoulder impingement because arthritis can narrow the space that your soft tissue has in which to move.
How Does It Affect You? How Serious Is It?
Sleeping with rotator cuff injury or shoulder impingement is never ideal. Some may even wonder whether the act of sleeping in the wrong position can of itself result in the shoulder impingement or rotator cuff injury; this means that if you’re a side sleeper, the side you sleep on can be more prone to shoulder injuries, such as rotator cuff injuries, shoulder impingement, and tendinitis. Knowing the best sleeping positions for shoulder impingement and other shoulder-related injuries can help alleviate the pain at night. Sleeping with shoulder impingement or a rotator cuff injury can result in sleepless nights and grogginess the next morning. To sleep comfortably with a shoulder injury, knowing the best sleeping positions can make a world of difference! Below are the best sleeping postures for shoulder impingement…
Sleeping on your back – The best sleeping position for shoulder impingement is sleeping on your back. When you sleep on your back, little to no pressure is placed on your shoulders, neck, and back; this neutral position can therefore provide a pain-free sleeping posture for shoulder pain and help keep your spine aligned.
Sleeping on your side – Sleeping on your side is the worst sleeping position if you are dealing with shoulder impingement. However, if this is the only way you can get some shut-eye, you should consider sleeping on the pain-free shoulder!
Sleeping on your stomach – While sleeping on your stomach can cause increased pain from shoulder impingement, you can alleviate pain with proper support. If you need to sleep on your stomach to get a good night’s rest, place a pillow underneath your hips and pelvis; this will help align your lower body with your upper body to prevent your shoulders from sagging. You can also place a rolled-up blanket or towel underneath your shoulders for added support.
Recommended Treatment & Rehabilitation
An X-ray or MRI are extremely helpful when identifying shoulder impingement syndrome – they help to rule out other conditions that could be causing your discomfort. Before meeting with a physiotherapist, your doctor may refer you to perform one of the tests mentioned. Your physiotherapist will perform a thorough evaluation – they will assess the degree of your condition or injury and determine any factors that can be contributing to it. Shoulder impingement syndrome can be the result of a single injury. However, it is much more likely that it develops over time due to repeated irritation in the shoulder region. Your physiotherapist will then begin by gathering information about your condition. This will include your medical history. They may be assisted by different forms you fill out before your first session. After a few questions are answered, they will note any activities that make your symptoms worse or better – this information helps your physiotherapist better understand your condition and determines the course of your physical examination. The physical exam will vary, but most often will begin with observing movements discussed during the interview. It will include the region of your symptoms and other neighboring areas that may have changed since your symptoms began. For example, your physiotherapist may examine your lower arm, neck, and posture.
During your physical exam, your physiotherapist will:
- Watch you move your arm and shoulder overhead and perform other reaching tasks.
- Assess the mobility and strength of your shoulder and other regions of the body.
- Gently, but skillfully palpate your shoulder and surrounding area to determine exactly where it is most painful.
The physical exam will help determine the areas that require treatment to improve your condition. Your physical therapist will discuss their findings and work together with you to develop a program that begins your recovery. The goal of treatment for shoulder impingement syndrome is to reduce your pain and restore shoulder function – treatments for impingement syndrome include rest, ice, over-the-counter anti-inflammatory medications, steroid injections, and physiotherapy:
- Physiotherapy is the most important treatment for shoulder impingement syndrome – in most cases, you will only need one or two visits to learn how to continue to do physiotherapy on your own at home. You’ll learn stretching exercises to improve the range of motion of your shoulder, and as your pain lessens, you can begin strengthening exercises to improve your rotator cuff muscles.
- Ice should be applied to the shoulder for 20 minutes once or twice a day.
- If your healthcare provider approves, ibuprofen or naproxen may be taken as needed to relieve pain. For more severe pain, a stronger prescription strength anti-inflammatory medication may be prescribed, or a cortisone injection into the bursa beneath the acromion may be given.
- A common-sense approach to activities is helpful – avoid activities in which you need to frequently reach overhead or behind your back; these motions usually make shoulders with impingement syndrome worse. Stop activities that involve these motions until your pain improves.
Surgery is recommended if any nonsurgical treatments do not relieve your pain. One surgery called subacromial decompression or arthroscopic shoulder decompression, removes part of the acromion to create more space for the rotator cuff.
It’s best to rest your shoulder, but you can do some light exercises to stretch the muscles in the arm, shoulder, and chest in conjunction with strengthening your rotator cuff. These exercises will help to avoid worsening shoulder impingement syndrome.
Blade squeezes – Sit or stand and pinch your scapula together like you are pinching a small ball between them. Finally, hold for 5 seconds and do this 10 times. Perform this exercise 3 to 5 times a day.
Pec stretching – Stand in a doorway with your hand holding on to the door frame just below shoulder height. Afterwards, turn your body away from your arm until you feel a stretch in the chest area. Hold for 15 seconds and then repeat the procedure 5 times.
Arm stretches – Lie on your uninjured side and bend your top arm at a 90-degree angle. Then keep your elbow on your hip and rotate the lower arm toward the ceiling. Repeat 10 to 20 times.
Shoulder stretches – Stretch your arm straight in front of you and move it forwards only using your shoulder. Then move your shoulder backwards as far as you can, without moving your back or neck, whilst also avoiding any bending of your arm.
Alternative & Homeopathic Treatment
Shoulder impingement usually takes about three to six months to heal completely. More severe cases can take up to a year to heal. However, you can usually start returning to your normal activities within two to four weeks.
R.I.C.E. is an acronym that patients and athletes must remember for how best to treat a minor muscle injury; it stands for Rest, Ice, Compression, and Elevation:
- Rest the injury immediately.
- Ice the area as soon as possible in order to reduce further swelling and inflammation.
- Compress the area to limit swelling and bleeding.
- Elevate the elbow above the heart to improve fluid drainage.