What is Shoulder Impingement?
Shoulder impingement is a condition in which your rotator cuff rubs against the bony projection on your shoulder blade’s upper end, called acromion, giving rise to shoulder pain.
The rotator cuff is a set of four muscles and their tendons that pass from your upper arm bone to the shoulder. We use them to lift and rotate our arm. The cuff is sandwiched between the acromion above and the arm bone below, and can thus easily get irritated as you lift the arm.
Moreover, situated beneath the acromion and above the rotator cuff tendons, is a narrow space called bursa that functions to cushion the shoulder tendons and reduce friction by providing a bit of room. That said, whenever you lift your arm, the bursa between the rotator cuff and acromion tends to shrink further. The crossing tendons thus become very much prone to irritation and/or inflammation by the bones.
We, therefore, also refer to shoulder impingement as rotator cuff tendinitis, or inflammation of the rotator cuff. The bursa can also get inflamed due to the repeated arm lifting and rubbing of tendons and bones in the already compact shoulder region. Hence, the condition is also known as shoulder bursitis.
What factors increase your risk?
Shoulder impingement is most common in:
- Sports that require repeated use of arms above the shoulder level for prolonged periods, such as:
- Swimming
- Volleyball
- Badminton
- Basketball
- Tennis
- Job or activities that require you to reach out and lift your arm frequently, such as:
- Painting
- Working as a shelf stocker in store
- Doing construction work
- Electrician jobs
What are the Symptoms?
The condition typically manifests as sharp shoulder pain, especially during overhead strokes and serves in athletes. The pain intensifies when reaching up behind your back or raising the arm overhead.
How to know if you have Shoulder Impingement?
Although the actual diagnosis is made by your doctor, there are a few tests that you can carry out yourself to detect shoulder impingement. However, do keep in mind that having a positive test doesn’t necessarily mean that you have impingement or a negative test doesn’t always rule out the condition.
1. Hawkins test
Raise the arm with your elbow bent at about 90 degrees. Then bring that arm in front of your body and internally rotate it such that your elbow is raised up while your forearm is lowered. This action narrows the space between the acromion and the rotator cuff, reproducing pain in the shoulder.
2. Painful arch test
Slowly abduct your arm by moving it to the side away from the midline of your body and then raising your arm with the elbow in the extended position and thumb facing up. Experiencing pain with the arm abducted in the 60° to 120° plane indicates there’s something wrong with the space beneath the acromion.
3. Modified Hawkins test
Lift one arm, move it across your chest to grasp the opposite shoulder and then actively elevate that arm. Shoulder pain on the elevation side may signal shoulder impingement.
How is Shoulder Impingement treated?
The first-line treatment is conservative, such as with rest, anti-inflammatory medicines, injections, exercises, physical therapy, and modifying activities (such as avoiding overhead use of the arm at least in the initial phases). These simple measures yield satisfactory results within 2 years in more than 50% of cases.
If symptoms persist, Dr. Shapiro recommends decompressive surgery provided the rotator cuff is not torn. This procedure involves removing portions of the bony prominence or spurs and the inflamed bursa to allow more room for the structures within the compact shoulder region.
If you have shoulder pain, you may visit Dr. Shapiro to learn what may be causing your pain and to get the right treatment on time.
