Shoulder Impingement includes a group of conditions (also known as trapped tendons, tendonitis, and bursitis) where one of these structures becomes squashed between the bones in the shoulder that then becomes inflamed and painful.
Shoulder Impingement: About your shoulder
The shoulder joint is a ball and socket joint. The ball is at the top of your arm bone (humerus) and the socket is part of the shoulder blade. Above the joint is a ligament and a bone prominence called the acromion.
The gap between the humerus and the acromion is known as the sub-acromial space.
Your rotator cuff muscles help to move your shoulder. One of these 4 muscle tendons (supraspinatus) passes through this sub-acromial space. A small fluid-filled cushion called a bursa protects the tendon from the roof of the arch. During arm movement, your rotator cuff muscles work together to try to maintain a stable shoulder and to maintain this sub-acromial space.
So what is Shoulder Impingement?
The rotator cuff tendons are susceptible to wear and tear. Particularly with overhead activities, the supraspinatus tendon can get caught in the sub-acromial space. This can lead to inflammation and sometimes tears in the tendon. This irritation can lead to pain and weakness in the tendon.
Once the tendon is affected, it swells, reducing the size of the sub-acromial space, which then increases the chances of the tendon or the bursa becoming pinched. This is known as impingement.
How common is it?
Very! It is the most common shoulder problem. It can affect up to 20% of up at some point in our lives (most frequently between the ages 45-65).
Why does it occur?
The exact cause of sub-acromial impingement is unknown. It appears some people may be susceptible to wear-and-tear. The problem occurs within the tendon when it appears to fray and split. Often changes in posture or activity when the tendon is stressed may then cause episodes of pain.
What are the symptoms?
The main complaint is pain, felt on the outside of the upper arm. Pain is commonly felt with twisting movements such as putting on a jacket or reaching around for a seat belt. When inflammation is active, you may also experience pain at night
What tests can be done?
The main way to diagnose a shoulder impingement is by a clinical examination. Sometimes an ultrasound scan or MRI can be used if there is a suspicion that the tendon is torn.
What Treatment can I have?
Physiotherapy; an assessment of your shoulder will be carried out and from this an individualised programme of exercises given. These may include exercises to strengthen the muscle around your shoulder blade, to improve your posture and core stability, and stretches and/or strengthening of your rotator cuff muscles.
Injections; are sometimes given into the sub-acromial space (not into the tendon itself!). This is far more persistent and irritable shoulder pain. It usually consists of a mixture of local anaesthetic and steroid. This helps pain and decreases inflammation in the joint.
How can I reduce the stress on the tendon?
1) If possible stop the activity that causes the pain or find a different way of doing it.
2) Think about your posture! Maintaining a good posture helps to keep your shoulder aligned which will decrease the stress through your shoulder joint.
3) Improve your shoulder stability and your core strength with regular exercise to optimise the healthy function of your shoulder.
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