Shoulder impingement syndrome is a frequent source of shoulder pain, occurring when the bones of the shoulder put pressure on the soft tissues within the joint. The shoulder is a highly mobile joint, composed of three bones: the humerus (arm bone), scapula (shoulder blade), and clavicle (collarbone). Of these, only the clavicle connects the shoulder to the rest of the bodyâs skeleton, contributing to both the shoulderâs limited stability and its wide range of motion.
Because the shoulder joint lacks strong structural support, it relies on surrounding muscles and tissues for stability. Any imbalance, weakness, or injury in these structures can lead to dysfunction, pain, and a reduction in movement.
Anatomy of the Shoulder and the Subacromial Space
The acromion is a part of the shoulder blade that forms a “roof” over the shoulder joint. Beneath this roof lies a narrow space known as the subacromial space. When you raise your arm, this space becomes even more compressed, which can lead to irritation of the various structures that pass through it. These include:
- The rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) that stabilize the shoulder and control its movement.
- The long head of the biceps tendon, which helps stabilize the front of the joint.
- The subacromial bursa, a fluid-filled sac that cushions the area between the acromion and the tendon of the supraspinatus muscle.
Any condition that reduces the space in this area can cause a form of impingement syndrome, including:
- Biceps tendinitis
- Subacromial bursitis
- Rotator cuff tendinitis
- Rotator cuff tears
- Calcific tendinitis
- Repetitive strain injury (RSI)
Symptoms of Shoulder Impingement Syndrome
Pain typically develops gradually over time, rather than following a specific injury. It is usually worse with movement, especially overhead, and often worsens at night. Common symptoms include:
- Pain when raising the arm above head height.
- Discomfort when lifting the arm out to the side.
- Soreness when reaching behind the back.
- Night pain, often disrupting sleep.
- Dull aching that may radiate into the neck, back, or upper arm.
Causes of shoulder impingement
There are several potential causes of shoulder impingement syndrome, which may act individually or in combination:
- Age: As we age, the tendons, ligaments, and muscles in the shoulder lose strength and become less able to repair themselves.
- Poor posture: Forward-rounded shoulders can narrow the subacromial space, causing friction and damage to tissues. Over time, poor posture can also disrupt blood circulation in this area, leading to degeneration of the tissues.
- Overuse: Repetitive motions or heavy lifting can cause microtrauma to the muscles and tendons. If the rate of damage exceeds the rate of healing, it can result in tendinitis or tears.
- Muscle weakness: Weakness or fatigue in the rotator cuff muscles can make them more susceptible to injury, especially when theyâre overworked. Many people do not perform rotator cuff-specific strengthening exercises, which can lead to imbalances.
- Instability: Shoulder instability due to hypermobility or previous dislocations can increase the risk of impingement. When the ball of the shoulder doesnât remain centered in the socket, it places additional strain on the surrounding tissues.
- Stiffness: Tightness in the shoulderâs fibrous joint capsule can cause the humeral head (ball) to move abnormally within the socket, increasing friction on the subacromial tissues.
Diagnosis of Shoulder Impingement Syndrome
In most cases, a thorough medical history and physical examination are sufficient to diagnose shoulder impingement. However, if the diagnosis remains unclear, your doctor or osteopath may recommend imaging tests such as an X-ray, ultrasound, or MRI scan to rule out conditions like rotator cuff tears, calcific tendinitis, or arthritis.
Treatment of Shoulder Impingement Syndrome
Shoulder impingement can often be treated conservatively, without the need for surgery. Osteopathic treatment, combined with lifestyle changes and exercises, can help alleviate pain and promote healing. Typical treatment may include:
- Avoidance of aggravating activities: The first step is to stop or modify activities that worsen the pain.
- Improving circulation and movement: Osteopathic techniques can improve blood flow and reduce muscle tension, promoting faster healing.
- Correcting posture: Addressing postural issues that contribute to shoulder dysfunction can help reduce strain on the affected muscles and tendons.
- Strengthening exercises: Your osteopath may guide you through targeted exercises designed to strengthen the rotator cuff and improve shoulder stability, helping to prevent recurrence. FREE home shoulder exercise program.
Healing, especially of tendon injuries, is a slow process. Symptoms may take anywhere from 4 to 12 weeks to resolve fully, depending on the severity of the condition. If left untreated or aggravated, impingement can lead to more serious conditions like tendon tears or chronic pain.
Top 6 Tips for Managing Shoulder Impingement Syndrome
- Incorporate gentle exercise: Aerobic activity improves cardiovascular health, which in turn promotes better circulation and tissue repair.Here are the top 6 recommendations if your suffering with shoulder impingement syndrome:
- Modify or stop painful activities: Identify and avoid activities that exacerbate your pain, especially overhead movements.
- Consult a healthcare professional: Seek advice from a trained osteopath or other musculoskeletal expert for diagnosis and treatment.
- Apply ice: Ice therapy can help reduce pain and swelling, particularly in the early stages. Apply an ice pack for 10â15 minutes, 2â4 times a day. Be sure to wrap the ice in a cloth to avoid direct contact with the skin.
- Use anti-inflammatory medications: Non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, can reduce inflammation and relieve pain, particularly in the early stages of impingement.
- Quit smoking: Smoking impairs circulation to the muscles and tendons, slowing the healing process and increasing the risk of further injury.
FREE shoulder impingement exercise plan
Shoulder Impingement Exercise Plan
For those suffering from shoulder impingement, following a structured exercise plan is essential. We offer a free shoulder impingement exercise plan to help you strengthen the muscles around the joint, improve flexibility, and reduce pain. Please get in touch with our clinic to access this plan and begin your recovery journey.
Shoulder Impingement Treatment in Enfield
If youâre suffering from shoulder impingement syndrome and live in or around Enfield, North London, our clinic, GD Osteopathy & Sports Massage, can help. We specialise in treating musculoskeletal conditions, including shoulder impingement, using a combination of osteopathic techniques, tailored exercises, and rehabilitation strategies. Whether youâre experiencing mild discomfort or more severe pain, our experienced team will work with you to create a personalised treatment plan to ease your symptoms and improve your shoulder function.
Contact us today to schedule a consultation and begin your recovery process.