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Shoulder Impingement: Treatment to Relieve Pain and Improve Movement

Conditions & Treatments

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Introduction

Shoulder impingement syndrome is a common condition in athletes and active individuals, characterized by pain and limited range of motion in the shoulder. It occurs when the rotator cuff tendons become compressed or irritated as they pass through the subacromial space.

Anatomy:

The shoulder joint is a complex structure consisting of:

• Glenohumeral joint

• Acromioclavicular joint

• Sternoclavicular joint

• Scapulothoracic articulation

Key structures involved in impingement:

• Rotator cuff muscles (supraspinatus, infraspinatus, teres minor, subscapularis)

• Subacromial bursa

• Acromion

• Coracoacromial ligament

Etiology: Shoulder impingement can be classified as:

1. Primary (structural) impingement:

• Abnormal acromial morphology

• Acromioclavicular joint arthritis

• Coracoacromial ligament thickening

2. Secondary (functional) impingement:

• Rotator cuff weakness

• Scapular dyskinesis

• Glenohumeral instability

• Posterior capsular tightness

Risk Factors:

• Repetitive overhead activities (e.g., swimming, tennis, baseball)

• Poor posture

• Muscle imbalances

• Age-related degenerative changes

• Previous shoulder injuries

Clinical Presentation: Symptoms:

• Pain with overhead activities

• Night pain, especially when lying on the affected side

• Weakness in arm elevation and rotation

• Limited range of motion

Physical Examination:

• Painful arc (pain between 60-120 degrees of abduction)

• Positive impingement signs (Neer’s test, Hawkins-Kennedy test)

• Weakness in rotator cuff muscle testing

• Scapular dyskinesis

• Tenderness over the greater tuberosity or anterior acromion

Diagnostic Imaging:

 • X-rays: To evaluate acromial morphology and rule out other pathologies

• Ultrasound: Dynamic assessment of the rotator cuff and subacromial space

• MRI: Gold standard for evaluating soft tissue structures and ruling out concurrent pathologies

Differential Diagnosis:

• Rotator cuff tears

• Biceps tendinopathy

• Adhesive capsulitis (frozen shoulder)

• Acromioclavicular joint pathology

• Cervical radiculopathy

Management:

Conservative Treatment:

1. Activity modification:

  •  Avoid aggravating activities
  • Correct technique in sports-specific movements

Management:

Patients with a mild degree of acromioclavicular (AC) joint injury generally benefit from treatment with conservative therapies alone. Any pain and inflammation can be controlled with rest, ice, and non-steroidal anti-inflammatory medications (NSAIDs). Immobilizing the AC joint is important for proper healing of the ligaments as well as protecting the joint from additional damage. The shoulder pain can linger for months after an AC joint injury, therefore a physical therapy program focused on strengthening and improving the AC joint range of motion is strongly encouraged.

2. Physical therapy:

• Rotator cuff strengthening

• Scapular stabilization exercises

• Posterior capsule stretching

• Postural correction

3. Manual therapy:

• Soft tissue mobilization

• Joint mobilization/manipulation

4. Modalities:

• Ice/heat therapy

• Ultrasound

• Electrical stimulation

5. Medications:

• NSAIDs for pain and inflammation

• Topical analgesics

6. Corticosteroid injections:

• Subacromial injections for short-term pain relief

• Limited use due to potential negative effects on tendon healing

7. Platelet-rich plasma (PRP) injections:

• Emerging treatment option

• Mixed evidence on efficacy

Surgical Management:

Indicated when conservative measures fail after 3-6 months:

1. Arthroscopic subacromial decompression:

• Removal of inflamed bursa

• Acromioplasty to increase subacromial space

2. Rotator cuff repair (if concurrent tear present)

3. Biceps tenodesis (if biceps pathology present)

Prevention Strategies:

1. Proper warm-up and cool-down routines

2. Balanced strength training program:

• Rotator cuff strengthening

• Scapular stabilizers

• Core and lower body exercises

3. Flexibility exercises:

 • Posterior capsule stretching

• Pectoralis minor stretching

4. Proper technique in sports-specific movements:

• Swimming stroke analysis

• Throwing mechanics evaluation

5. Posture correction:

• Workplace ergonomics

• Daily postural awareness

6. Gradual progression in training intensity and volume

• Workplace ergonomics

• Daily postural awareness

7. Adequate rest and recovery between training sessions

Return to Sport:

• Individualized, sport-specific rehabilitation program

Criteria for return:

– Full, pain-free range of motion

– Restored rotator cuff and scapular muscle strength

– Normal scapulohumeral rhythm

– Successful completion of sport-specific functional tests

Gradual return to sport:

– Progressive increase in intensity and duration of activities

– Monitoring for symptom recurrence

Continued maintenance program:

– Regular stretching and strengthening exercises

– Proper warm-up routines

– Technique refinement

Prognosis:

• Most cases respond well to conservative management

• 60-90% success rate with proper rehabilitation

• Surgical outcomes generally favorable, with 80-90% patient satisfaction

Complications:

• Persistent pain and dysfunction

• Progression to rotator cuff tears

• Adhesive capsulitis

• Biceps tendon pathology

Emerging Treatments:

1. Shockwave therapy:

• Potential to stimulate tissue healing and reduce pain

• Mixed evidence on efficacy

2. Regenerative medicine:

• Stem cell therapy

• Growth factor injections

• Limited evidence, requires further research

3. Wearable technology:

• Biofeedback devices for posture and movement correction

• Load management tools for athletes

Conclusion:

Shoulder impingement syndrome is a common condition in sports medicine that requires a comprehensive approach to diagnosis and management. Early recognition, appropriate conservative treatment, and targeted rehabilitation are key to successful outcomes. For athletes, a focus on prevention strategies and proper biomechanics is crucial for long-term shoulder health and optimal performance.

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Shoulder

Resources

Shoulder Anatomy
Shoulder PT protocols

Conditions

Shoulder Impingement
AC joint injuries
Partial Thickness Rotator Cuff Tears
SICK Scapula Syndrome
Rotator Cuff Injuries
Labral and SLAP Tears
Shoulder Dislocation | Shoulder Instability
Throwing Shoulder Injuries
Shoulder Fractures

Treatments

Arthroscopic Shoulder Labral Repair Techniques
Advanced Treatment Options for Shoulder Osteoarthritis
Arthroscopic Rotator Cuff Repair
Labral-SLAP Repairs
Shoulder Instability Repairs
AC Joint Reconstruction
Biceps Surgery
Shoulder Tendon Repairs
Shoulder Dislocation Repair
Pectoralis Major Tendon Repair
Frozen Shoulder Repair
Clavicle Fracture Repair
Diagnostic Shoulder Arthroscopy
Biceps tenodesis
Arthroscopic SLAP repair surgery
Arthroscopic Capsular Release
BMAC stem cell injections for Shoulder Pain