Shoulder Impingement

What’s really going on inside

Shoulder impingement is often caused by altered scapular (shoulder blade) position, often described as ‘winging’. The scapular is noted to be more anteriorly (forward) and laterally (to the side) rotated. This causes a decrease in the space for shoulder tendons, bursae and nerves to run through and work in, which can lead to an decrease in the space in this area and compression of the structures which may result in possible tissue and / or nerve damage.

The overhead action of throwing or taking the arm up over the head can generate a lot of force through the shoulder. This repetitive action can lead to some of the muscles around the shoulder to become tight and weaker while other muscles around the shoulder become stronger. This may result in shortening of the shoulder joint capsule and the supporting muscles around it. Unfortunately this can result in a “SICK” shoulder (Scapular mal-position, Inferior medial border prominence, Coracoid pain and mal-position, and dyskinesis of scapular). In other words: a shoulder that isn’t sitting as it normally would, with pain and movement dysfunction. The resulting muscle imbalance causes a shift in the position and movement of the scapula on the shoulder. An altered movement pattern results causing more stress and load on the surrounding structures resulting in further trauma, which may lead to tissue and/or nerve damage. Tenderness may be found on the bony parts of the shoulder joint where the muscles insert due, to the altered scapula position and increased tension on these soft tissue structures.

How a physio can help

To start to reduce the pain your physio may ask you to follow the steps below:

• Rest.
• Ice.
• Your doctor may prescribe anti-inflammatory medications or pain relief medication.
• Movement within the pain free range will help in maintaining mobility of the surrounding structures.
• No throwing or over arm technique until the pain settles.
• Avoiding things that are painful.
• Your physiotherapist can use different treatment techniques, for pain and inflammation.

As Pain settles:

•  You will begin a rehabilitation program that includes strengthening and stretching exercises to help re-establish your shoulder stability and restore normal shoulder motion.
• Massage and mobility exercises may be incorporated to ensure normal function and movement is achieved.
• A throwing program can now commence under the guidance of
  your physiotherapist. It is important to not do too much at this stage as symptoms may return if you try to push yourself too quickly.
• Swimmers and tennis players will return to stroke work and hitting.
• Returning to Sport:  Return to sport is possible when you have no localised tenderness, full range of pain free movement has been achieved and your strength is back to normal.
  – Your physiotherapist will guide you from a throwing program back to competitive throwing and inform you of any precautions that need to be taken.
  – Your coach or physiotherapist should check your over arm / throwing/ stroke/hitting technique to prevent reoccurrence. The smallest adjustments can make a huge difference.
  – You should continue strengthening lower limb, core and your up-per body to prevent reoccurrence.