Impingement is a byproduct of dysfunction or pathology of the shoulder.
The rotator cuff muscles help to stabilise the shoulder joint and also help with shoulder movement. The four tendons of the rotator muscles attach on to the head of the humerus. There is a space underneath the acromion of the scapula called the subacrominal space. The rotator cuff tendon passes through here. Narrowing of this space can cause compression and irritation of the tendons resulting in ’impingement’ pain.
Signs & Symptoms
Anterolateral shoulder pain
Painful arc of shoulder movement
Aggravated with raising arms over head or reaching out the side
Weakness with arm power
Reduced range of shoulder movement (e.g. increased difficulty with hand behind back)
What Causes It?
Long hooked acromion – osteophyte formation
Instability of the glenohumeral joint
Rotator cuff degeneration or tendinopathy
Poor scapulohumeral rhythm
Elevation of the head of humerus
Excessive load on rotator cuff muscles (swimming, throwing, overhead work)
How to Self Manage
Follow the R.I.C.E. protocol
If not contraindicated, a course of non-steroidal anti-inflammatory medication can help to reduce inflammation.
Avoiding aggravating activities is also recommended to reduce aggravating the tendons.
In the case where nonsurgical treatment is unsuccessful, surgery may be recommended:
If there is severe tendon degeneration, this may be repaired.
If the acromion is beaked or there is osteophyte formation, surgery may be required to remove the obstruction causing impingement.
A cortisone injection may be trialed to ‘shrink’ the bursa if that is enlarged and causing the impingement pain.
How Physio Helps
Take an accurate history of your shoulder problem
Assess your posture
Review your shoulder biomechanics
Assess for muscle imbalance
Review your gym program and make necessary modifications to reduce and prevent impingement symtpoms
Provide manual treatment which may include (soft tissue massage, joint mobilisation, dry needling or acupuncture, and electrophysical agents)
Prescribe an exercise program involving scapular setting, rotator cuff strengthening, and other specific rehab exercises to address areas of imbalance and reduced control and stability.
NOTE: Conservative management involves exercise prescription. The causative factors need to be addressed and corrected to prevent ongoing pain or future recurrence. Diligence with home exercises is a MUST.