Secondary Shoulder Impingement Syndrome

What is Secondary Shoulder Impingement Syndrome

Secondary Shoulder impingement syndrome occurs when movement of the shoulder joint is abnormal.

Shoulder impingement syndrome is a condition that causes pain when connective tissues (tendons) surrounding the shoulder joint become pinched.

These tendons are part of the group of muscles and tissues that help to stabilize the shoulder (rotator cuff). There are two types of impingement syndrome: primary and secondary.

This can happen if there is too much movement (laxity), too little movement (stiffness), or abnormal movement.

The shoulder impingement syndrome is a chronic, painful condition of the shoulder that results from an encroachment of the tendons of the rotator cuff (most commonly the supraspinatus), occurring most commonly with shoulder abduction.

In the normal functioning shoulder, the rotator cuff serves as a dynamic stabilizer of the joint. Its principal function lies in humeral head depression during shoulder abduction.

The rotator cuff also assists with early abduction (0–30 degrees) as well as with internal and external rotation. When the rotator cuff is inflamed secondary to chronic, repetitive, microtrauma, or acute posttraumatic tendon strain, it becomes relatively ineffective at shoulder depression, a characteristic called reflex inhibition.

Consequently, the humeral head moves closer to the coracoacromial arch (called superior translation) during contraction of the deltoid muscle (shoulder abduction). With continued motion and increased superior translation of the humeral head, there is impingement of the tendons on the coracoacromial arch, which leads to tendon inflammation and increased reflex inhibition.

This is the vicious cycle of impingement and can lead to rotator cuff tears or voluntary decreased motion to avoid pain with resultant adhesive capsulitis

What are the causes?

This condition may be caused by:

  • Shoulder blade muscles that are weak or uncoordinated (scapular dyskinesis).
  • Glenohumeral instability. This is too much movement of the upper arm bone (humerus). This can result from:
    • Having loose joints.
    • An injury that happened during repeated overhead arm movements, such as throwing.
  • A hard, direct hit (blow) to the shoulder. This is rare.

What increases the risk?

You may be more likely to develop this condition if you have injured your shoulder in the past or if you are an athlete who participates in:

  • Sports that involve throwing, such as baseball.
  • Tennis.
  • Swimming.
  • Volleyball.

What are the signs or symptoms?

The main symptom of this condition is pain on the front or side of the shoulder. Pain may:

  • Get worse when lifting or raising the arm.
  • Get worse at night.
  • Wake you up from sleeping.
  • Feel sharp when the shoulder is moved, and then fade to an ache.

Other signs and symptoms may include:

  • Tenderness.
  • Stiffness.
  • Inability to raise the arm above shoulder level or behind the body.
  • Weakness.

How is this diagnosed?

This condition may be diagnosed based on:

  • Your symptoms.
  • Your medical history.
  • A physical exam.
  • Imaging tests, such as:
    • X-rays.
    • MRI.
    • Ultrasound.

How is this treated?

Treatment for this condition may include:

  • Resting your shoulder and avoiding all activities that cause pain or put stress on the shoulder.
  • Icing your shoulder.
  • NSAIDs to help reduce pain and swelling.
  • One or more injections of medicines to numb the area and reduce inflammation.
  • Physical therapy.
  • Surgery. This may be needed if nonsurgical treatments do not help. Surgery may involve stabilizing your shoulder and repairing your rotator cuff, as needed.

Follow these instructions at home:

Managing pain, stiffness, and swelling

  • If directed, put ice on the injured area.
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day.

Activity

  • Rest and return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
  • Do exercises as told by your health care provider.

General instructions

  • Do not use any tobacco products, including cigarettes, chewing tobacco, or e-cigarettes. Tobacco can delay healing. If you need help quitting, ask your health care provider.
  • Ask your health care provider when it is safe for you to drive.
  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

  • Give your body time to rest between periods of activity.
  • Maintain physical fitness, including strength in your shoulder muscles and back muscles.

Contact a health care provider if:

  • Your symptoms have not improved after 2–3 months of treatment.
  • Your symptoms are getting worse.

Secondary Shoulder Impingement Syndrome Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercise

This exercise warms up your muscles and joints and improves the movement and flexibility of your neck and shoulder. This exercise also helps to relieve pain and stiffness.

Exercise A: Cervical side bend

  1. Using good posture, sit on a stable chair, or stand up.
  2. Without moving your shoulders, slowly tilt your left / right ear toward your left / right shoulder until you feel a stretch in your neck muscles. You should be looking straight ahead.
  3. Hold for __________ seconds.
  4. Slowly return to the starting position.
  5. Repeat on your left / right side.

Repeat __________ times. Complete this exercise __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your shoulder. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise B: Scapular protraction, supine

  1. Lie on your back on a firm surface. Hold a __________ weight in your left / right hand.
  2. Raise your left / right arm straight into the air so your hand is directly above your shoulder joint.
  3. Push the weight into the air so your shoulder lifts off of the surface that you are lying on. Do not move your head, neck, or back.
  4. Hold for __________ seconds.
  5. Slowly return to the starting position. Let your muscles relax completely before you repeat this exercise.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise C: Scapular retraction

  1. Sit in a stable chair without armrests, or stand.
  2. Secure an exercise band to a stable object in front of you so the band is at shoulder height.
  3. Hold one end of the exercise band in each hand. Your palms should face down.
  4. Squeeze your shoulder blades together and move your elbows slightly behind you. Do not shrug your shoulders while you do this.
  5. Hold for __________ seconds.
  6. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Shoulder extension with scapular retraction

  1. Sit in a stable chair without armrests, or stand.
  2. Secure an exercise band to a stable object in front of you where it is above shoulder height.
  3. Hold one end of the exercise band in each hand.
  4. Straighten your elbows and lift your hands up to shoulder height.
  5. Squeeze your shoulder blades together and pull your hands down to the sides of your thighs. Stop when your hands are straight down by your sides. Do not let your hands go behind your body.
  6. Hold for __________ seconds.
  7. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Shoulder abduction

  1. Sit in a stable chair without armrests, or stand.
  2. If directed, hold a __________ weight in your left / right hand.
  3. Start with your arms straight down. Turn your left / right hand so your palm faces in, toward your body.
  4. Slowly lift your left / right hand out to your side. Do not lift your hand above shoulder height.
    1. Keep your arms straight.
    1. Avoid shrugging your shoulder while you do this movement. Keep your shoulder blade tucked down toward the middle of your back.
  5. Hold for __________ seconds.
  6. Slowly lower your arm, and return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

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