What is a Shoulder Impingement?

by Aug 13, 2018Anatomy, Injuries

How do you know if you have shoulder impingement?

Shoulder impingements is a frequently diagnosed shoulder conditions.

A shoulder impingement is a condition where your shoulders rotator cuff tendons are trapped and compressed during shoulder movements. This causes injury to the shoulder tendons and bursa resulting in painful shoulder movements.

Shoulder Impingement

Anatomy of the Shoulder

So what exactly are Tendons and Bursa?

Tendons attach the ends muscle to bone and Bursa are fluid filled sacs that protect a joint. 

Your shoulders rotator cuff is made of four small muscles that help hold the humerus (arm bone ) into your shoulder socket.

The shoulder joint is protected by a bony arch called the acromion that is located at the end of your collar bone. Directly underneath the acromion is a space, called the subacromial space where many tendons and bursa are located. 

Shoulder impingements occur when the tendons of your shoulders rotator cuff muscles, or the bursa in the shoulder joint are repeatedly trapped and compressed during your shoulder movements. They become irritated and inflamed; causing pain, weakness, and loss of movement.

Cause of Shoulder Impingement

In this image, the tendons and bursa in the subacromial space are irritated causing shoulder impingement. 

There are two types of Shoulder Impingements

Primary Shoulder Impingements – Structural Narrowing

Primary shoulder impingements are structure related. Some people have conditions like osteoarthritis that cause their subacromial ( space below the acromion ) space to narrow. Having a more narrow subacromial space makes you more likely to compress, impinge, and irritate your soft tissues the run through it.

Secondary Shoulder Impingements – Dynamic Shoulder Instability

Secondary shoulder impingements are related to posture and movement. Repeated overhead activity, joint movement, trauma, injury, inactivity, or poor posture can lead to having a dynamically unstable shoulder and muscular weakness. This means that there is a combination of excessive joint movement, ligament laxity and muscular weakness around the shoulder joint. 

This type of shoulder pain usually occurs over time due to repetitive overactivity or inactivity of the shoulder. 

In an unstable shoulder, the rotator cuff has to work harder, which can cause injury. A fatigued rotator cuff, eventually becomes inflamed causing irritation. The job of the rotator cuff is to hold the head of the humerus ( arm bone ) into the shoulder socket. If it is not working optimally, the tendons or other structures in your shoulder may be compressed causing pain. 

Rest and strengthening under the supervision of a physiotherapy can help restore full function and strenght of the shoulder. 

Primary Shoulder Impingement

Primary Shoulder Impingement: As you can see in the image, the subacromial space (space below the acromion has decreased causing an impingement).

How Do I Know if I Have a Shoulder Impingement?

Shoulder impingements vary in type and severity from mild tendonitis (tendon inflammation) to partial or full rotator cuff tendon tears that require surgery.

The most common symptoms of shoulder impingements are:

  • loss of movement
  • Weakness, and pain during shoulder movement
  • Pain tends to increase with excessive overhead movement
  • Pain can worsen over night if the affected shoulder is slept on
  • Shoulder impingement pain can be felt anywhere between your shoulder and elbow.

What Can I Do to Help My Shoulder Impingement?

If you have pain in your shoulder, come in to see a physiotherapist to have it assessed. 

Your rotator cuff muscles play a very important role in keeping your shoulder joint stable and under control, helping prevent injuries like impingements and dislocations.

After resting, regaining full range of motion, and taking the right pain relief and anti-inflammatory precautions, the best thing you can do to help your shoulder impingement and prevent future ones is improve your rotator cuff strength.

A few great rotator cuff exercises you should try if you’re well rested and pain free are:

  • Internal Shoulder Rotations

  • External Shoulder Rotations

  • Dumbbell Rows

  • Reverse Flys

  • Planks

  • Scapular Face Pulls