Shoulder Impingement Syndrome: Cause, Symptoms, Treatment, Exercise

What is a Shoulder impingement syndrome?

Shoulder Impingement Syndrome

Shoulder impingement syndrome (SIS) is a condition where the soft tissues in the shoulder joint become compressed or pinched, causing pain, inflammation, and limited movement. This compression typically occurs in the subacromial space, which is the narrow passageway between the acromion (a bony protrusion at the top of the shoulder blade) and the rotator cuff tendons.

The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint and help to stabilize and move the shoulder. When the rotator cuff tendons become inflamed or irritated, they can swell and thicken, making it more difficult for them to move smoothly through the subacromial space. This can lead to rubbing and compression of the tendons and other soft tissues, causing pain and discomfort.

SIS can be caused by a variety of factors, including overuse, poor posture, muscle imbalances, and structural abnormalities in the shoulder joint. It is a common condition among athletes, particularly those who engage in overhead activities such as throwing, swimming, or weightlifting.

Treatment for SIS typically involves rest, physical therapy, and anti-inflammatory medications. In more severe cases, surgery may be necessary to relieve compression in the subacromial space.

Related Anatomy

To understand shoulder impingement syndrome (SIS), it is important to have a basic understanding of the anatomy of the shoulder joint.

The shoulder joint is a ball-and-socket joint that connects the upper arm bone (humerus) to the shoulder blade (scapula). The ball of the joint is formed by the rounded end of the humerus, while the socket is formed by a shallow depression on the scapula called the glenoid fossa. The joint is stabilized by a group of muscles and tendons called the rotator cuff, which wraps around the head of the humerus and helps to hold it in place within the socket.

The subacromial space is a narrow passageway between the acromion, a bony projection of the scapula, and the rotator cuff tendons. The space is lined with a lubricating sac called the subacromial bursa, which helps to reduce friction as the tendons move through the space. When the rotator cuff tendons become inflamed or irritated, they can swell and thicken, making it more difficult for them to move smoothly through the subacromial space. This can lead to rubbing and compression of the tendons and other soft tissues, causing pain and discomfort.

Other important structures in the shoulder joint include the labrum, a ring of cartilage that helps to deepen the socket and provide additional stability to the joint, and the biceps tendon, which attaches the biceps muscle to the shoulder blade and helps to stabilize the joint during certain movements.

What are the causes of Shoulder impingement syndrome?

Shoulder impingement syndrome (SIS) can be caused by a variety of factors, including:

• Overuse: Activities that involve repetitive overhead movements, such as throwing a ball or painting a ceiling, can put a lot of stress on the rotator cuff tendons and lead to inflammation and irritation.
• Poor posture: Poor posture can cause the shoulder joint to become misaligned, which can put extra pressure on the rotator cuff tendons and lead to impingement.
• Muscle imbalances: Imbalances in the muscles that surround the shoulder joint can cause the joint to become unstable and increase the risk of impingement.
• Structural abnormalities: Some people are born with structural abnormalities in the shoulder joint, such as a hooked acromion or a narrow subacromial space, which can increase the risk of impingement.
• Trauma: A fall or other injury that causes damage to the rotator cuff tendons or other soft tissues in the shoulder can lead to impingement.
• Aging: As we age, the tendons in the rotator cuff can become weaker and more prone to injury and inflammation, which can increase the risk of impingement.

Other conditions: Certain medical conditions, such as arthritis, can cause inflammation and swelling in the shoulder joint, which can lead to impingement.

Symptoms of Shoulder impingement syndrome

The symptoms of shoulder impingement syndrome (SIS) can vary depending on the severity of the condition, but common symptoms include:

• Pain: Pain in the shoulder joint is the most common symptom of SIS. The pain is usually felt in the front or side of the shoulder and may be sharp or dull. The pain may be worse when the arm is lifted overhead or when the arm is moved away from the body.
• Weakness: Weakness in the affected arm is another common symptom of SIS. This can make it difficult to perform certain activities that require lifting or reaching, such as putting on a shirt or reaching for a high shelf.
• Limited range of motion: Impingement can limit the range of motion in the shoulder joint, making it difficult to move the arm in certain directions.
• Clicking or popping sounds: Some people with SIS may experience clicking or popping sounds in the shoulder joint when they move their arm.
• Swelling or inflammation: Inflammation and swelling in the shoulder joint may be present in more severe cases of SIS.
• Pain at night: Some people with SIS may experience pain that wakes them up at night, particularly if they sleep on the affected side.

If you are experiencing any of these symptoms, it is important to see a healthcare professional for an accurate diagnosis and appropriate treatment.

Risk factor

There are several risk factors that can increase the likelihood of developing shoulder impingement syndrome (SIS), including:

• Age: SIS is more common in older adults, as the tendons in the rotator cuff can weaken and become more prone to injury and inflammation with age.
• Overuse: Repetitive overhead activities, such as throwing a ball or painting a ceiling, can increase the risk of SIS by putting a lot of stress on the rotator cuff tendons.
• Poor posture: Poor posture can cause the shoulder joint to become misaligned, which can increase the risk of impingement.
• Muscle imbalances: Imbalances in the muscles that surround the shoulder joint can cause the joint to become unstable and increase the risk of impingement.
• Structural abnormalities: Some people are born with structural abnormalities in the shoulder joint, such as a hooked acromion or a narrow subacromial space, which can increase the risk of impingement.
• Previous shoulder injuries: Previous injuries to the shoulder, such as a dislocated shoulder or a rotator cuff tear, can increase the risk of developing SIS.
• Certain sports or activities: Athletes who engage in sports that require a lot of overhead movements, such as baseball or swimming, are at an increased risk of developing SIS.
• Occupation: Jobs that require repetitive overhead activities, such as construction or painting, can increase the risk of developing SIS.
• Genetics: Some people may be more predisposed to developing SIS due to genetic factors that affect the structure and function of the shoulder joint.

It's important to note that having one or more of these risk factors doesn't necessarily mean that someone will develop SIS, but it does increase their likelihood of developing the condition.

Differential Diagnosis

Shoulder impingement syndrome (SIS) can have similar symptoms to other conditions affecting the shoulder, so it's important to consider differential diagnoses when evaluating a patient with shoulder pain. Some potential differential diagnoses for SIS include:

• Rotator cuff tear: A rotator cuff tear is a tear in one or more of the rotator cuff tendons that can cause pain, weakness, and limited range of motion in the shoulder joint.
• Bursitis: Bursitis is inflammation of the bursae, small fluid-filled sacs that cushion the joints. In the shoulder, bursitis can cause pain, swelling, and limited range of motion.
• Frozen shoulder: Frozen shoulder, also known as adhesive capsulitis, is a condition in which the shoulder joint becomes stiff and painful, often as a result of injury or surgery.
• Shoulder arthritis: Arthritis in the shoulder joint can cause pain, stiffness, and limited range of motion in the shoulder.
• Labral tear: A labral tear is a tear in the labrum, a ring of cartilage that surrounds the shoulder joint. This can cause pain, weakness, and limited range of motion in the shoulder.
• Cervical spine disorders: Disorders affecting the cervical spine, such as cervical radiculopathy or herniated disc, can cause pain that radiates into the shoulder.
• Thoracic outlet syndrome: Thoracic outlet syndrome is a condition in which the nerves and blood vessels that pass through the thoracic outlet, a narrow space between the collarbone and first rib, become compressed. This can cause pain and numbness in the shoulder and arm.

A thorough evaluation by a healthcare professional can help differentiate between these conditions and determine the most appropriate treatment plan.

Diagnosis

The diagnosis of shoulder impingement syndrome (SIS) is typically made by a healthcare professional, such as a physician, orthopedist, or physical therapist. The diagnostic process usually involves a combination of a physical examination, medical history, and imaging tests.

During the physical examination, the healthcare professional will evaluate the range of motion of the shoulder joint, assess for areas of tenderness or swelling, and test the strength of the rotator cuff muscles. They may also perform special tests, such as the Neer or Hawkins-Kennedy test, which can help confirm a diagnosis of SIS.

A medical history will also be taken to assess for risk factors and previous injuries that may have contributed to the development of SIS.

Imaging tests, such as X-rays, ultrasound, or magnetic resonance imaging (MRI), may be ordered to confirm the diagnosis and evaluate the severity of the condition. X-rays can help rule out other conditions, such as arthritis or a fracture, while ultrasound or MRI can provide more detailed images of the soft tissues in the shoulder joint, such as the rotator cuff tendons and bursae.

Overall, a combination of physical examination, medical history, and imaging tests can help healthcare professionals diagnose SIS and develop an appropriate treatment plan.

Treatment of Shoulder impingement syndrome

The treatment of shoulder impingement syndrome (SIS) depends on the severity of the condition, as well as the patient's individual needs and goals. In general, treatment for SIS may include the following:

• Rest and activity modification: Resting the affected shoulder and avoiding activities that exacerbate the symptoms can help reduce pain and inflammation in the shoulder joint.
• Physical therapy: Physical therapy exercises can help improve the strength and flexibility of the rotator cuff muscles and improve the stability of the shoulder joint. This can help reduce the risk of impingement and improve shoulder function.
• Non-steroidal anti-inflammatory drugs (NSAIDs): Over-the-counter pain medications, such as ibuprofen or naproxen, can help reduce pain and inflammation in the shoulder joint.
• Corticosteroid injections: In some cases, corticosteroid injections may be used to reduce inflammation in the shoulder joint and provide pain relief.
• Surgery: In severe cases of SIS, surgery may be necessary to remove bone spurs or repair tears in the rotator cuff tendons. Surgery may also be recommended if conservative treatments have not been effective.
• Lifestyle modifications: Making lifestyle modifications, such as improving posture, maintaining a healthy weight, and avoiding activities that place excessive stress on the shoulder joint, can help reduce the risk of SIS and improve shoulder health.

It's important for patients with SIS to work closely with their healthcare professionals to develop a personalized treatment plan that addresses their specific needs and goals. With appropriate treatment, most people with SIS can expect to see improvements in their symptoms and shoulder function.

Physiotherapy treatment

Physiotherapy is a common and effective treatment option for shoulder impingement syndrome (SIS). Physiotherapy treatment for SIS may include the following:

• Range of motion exercises: Gentle range of motion exercises can help improve the flexibility of the shoulder joint and reduce stiffness.
• Strengthening exercises: Specific exercises that target the rotator cuff muscles can help improve strength and stability in the shoulder joint. This can help reduce the risk of impingement and improve shoulder function.
• Posture training: Poor posture can contribute to the development of SIS. Physiotherapists can provide guidance on proper posture and teach patients how to maintain good posture throughout the day.
• Manual therapy: Manual therapy techniques, such as massage or joint mobilization, can help reduce pain and improve mobility in the shoulder joint.
• Modalities: Modalities, such as ice or heat therapy, ultrasound, or electrical stimulation, can help reduce pain and inflammation in the shoulder joint.
• Education: Physiotherapists can provide education on proper body mechanics and ergonomics to reduce stress on the shoulder joint during daily activities.

Home exercise program: Physiotherapists can develop a customized home exercise program for patients to continue their exercises outside of the clinic and improve their shoulder function.

Overall, physiotherapy can be a highly effective treatment option for SIS. Working with a qualified physiotherapist can help patients reduce their pain, improve their shoulder function, and prevent the condition from worsening.

Exercise for Shoulder impingement syndrome

Exercise is an important component of treatment for shoulder impingement syndrome (SIS). However, the type and intensity of exercises will depend on the severity of the condition and the patient's individual needs and goals. Here are some exercises that may be helpful for patients with SIS:

• Pendulum exercise: Stand with one hand resting on a table or chair. Swing the opposite arm gently back and forth, and then in circles. This exercise can help improve range of motion and reduce stiffness in the shoulder joint.
• Scapular stabilization exercises: These exercises are designed to improve the strength and stability of the muscles surrounding the shoulder blade, which can help reduce the risk of impingement. Examples of scapular stabilization exercises include scapular retractions, wall slides, and shoulder blade squeezes.
• Rotator cuff strengthening exercises: Strengthening the rotator cuff muscles can help improve shoulder stability and reduce the risk of impingement. Examples of rotator cuff strengthening exercises include external rotations, internal rotations, and prone shoulder flexion.
• Shoulder stretches: Stretching the muscles in the shoulder can help improve flexibility and reduce tension in the joint. Examples of shoulder stretches include cross-body shoulder stretch, chest stretch, and shoulder blade stretch.
• Resistance band exercises: Resistance band exercises can be used to strengthen the shoulder muscles and improve shoulder function. Examples of resistance band exercises include external rotation with resistance band, internal rotation with resistance band, and shoulder abduction with resistance band.

It's important for patients with SIS to work closely with a qualified healthcare professional, such as a physiotherapist or exercise physiologist, to develop a personalized exercise program that addresses their specific needs and goals. Patients should also listen to their body and stop any exercise that causes pain or discomfort.