Shoulder Impingement Syndrome

What is Shoulder Impingement Syndrome

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).

Beneath the rotator cuff is a fluid-filled sac (bursa) that allows the muscles and tendons to glide smoothly. The bursa may become swollen or irritated (bursitis).

Bursitis, swelling in the rotator cuff tendons, or both conditions can decrease how much space is under a bone in the shoulder joint (acromion), resulting in impingement.

What are the causes?

Shoulder impingement syndrome can be caused by bursitis or swelling of the rotator cuff tendons, which may result from:

• Repetitive overhead arm movements.
• Falling onto the shoulder.
• Weakness in the shoulder muscles.

What increases the risk?

You may be more likely to develop this condition if you are an athlete who participates in:

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

Some people are also more likely to develop impingement syndrome because of the shape of their acromion bone.

What are the symptoms of Shoulder Impingement Syndrome?

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 have not helped. Surgery may involve repairing the rotator cuff, reshaping the acromion, or removing the bursa.

Follow these instructions at home:

Managing pain, stiffness, and swelling

• If directed, apply ice to 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.
• Be safe and responsible while being active to avoid falls.
• Maintain physical fitness, including strength and flexibility.

Contact a health care provider if:

• Your symptoms have not improved after 1–2 months of treatment and rest.
• You cannot lift your arm away from your body.

Shoulder Impingement Syndrome Rehab

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 shoulder. This exercise also helps to relieve pain and stiffness.

Exercise A: Passive horizontal adduction

1. Sit or stand and pull your left / right elbow across your chest, toward your other shoulder. Stop when you feel a gentle stretch in the back of your shoulder and upper arm.
   1. Keep your arm at shoulder height.
   1. Keep your arm as close to your body as you comfortably can.
2. Hold for __________ seconds.
3. Slowly return to the starting position.

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: External rotation, isometric

1. Stand or sit in a doorway, facing the door frame.
2. Bend your left / right elbow and place the back of your wrist against the door frame. Only your wrist should be touching the frame. Keep your upper arm at your side.
3. Gently press your wrist against the door frame, as if you are trying to push your arm away from your abdomen.
   1. Avoid shrugging your shoulder while you press your hand against the door frame. Keep your shoulder blade tucked down toward the middle of your back.
4. Hold for __________ seconds.
5. Slowly release the tension, and relax your muscles completely before you do the exercise again.

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

Exercise C: Internal rotation, isometric

1. Stand or sit in a doorway, facing the door frame.
2. Bend your left / right elbow and place the inside of your wrist against the door frame. Only your wrist should be touching the frame. Keep your upper arm at your side.
3. Gently press your wrist against the door frame, as if you are trying to push your arm toward your abdomen.
   1. Avoid shrugging your shoulder while you press your hand against the door frame. Keep your shoulder blade tucked down toward the middle of your back.
4. Hold for __________ seconds.
5. Slowly release the tension, and relax your muscles completely before you do the exercise again.

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

Exercise D: 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 E: 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 a few seconds.
6. Slowly return to the starting position.

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

Exercise F: Shoulder extension

1. Sit in a stable chair without armrests, or stand.
2. Secure an exercise band to a stable object in front of you where the band 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.