Shoulder Pain from Shoulder Impingement

“How did I get a shoulder impingement, doc?”

This was the question asked to me yesterday by a patient with shoulder pain after I had run through an assessment on his shoulder.
He had developed an acute case of shoulder pain after reaching down to grab and pull a garden hose during backyard clean up on the weekend.  The pain was debilitating as he described it and he could barely lift his arm higher than about 20 degrees for the first two days.  And sleeping has been nearly impossible.  However, this morning after taking a shower, inexplicably the pain seemed to ease up considerably and his range of motion was almost completely full with pain mainly when the shoulder was abducted to 90 degrees and beyond.

After a bit of questioning and having this patient go through a battery of orthopedic and functional tests, I told his gentleman that his pain was due to shoulder impingement…which elicited the question at the top of this blog post!

Shoulder impingement is a very common cause of shoulder pain.  It’s where the rotator cuff tendon is pinched or compressed underneath the lateral most part of your shoulder blade called the acromion.

It occurs commonly in middle-age (my patient is 50), but can affect anyone who engages in overhead activities (my patient has embarked on an exercise, weight-lifting program to lose weight and get healthier over the past 6 months).  The impingement pain can be felt at the front or back of the shoulder depending on how the impingement is occurring.

There is only a small amount of space between the acromion and the upper part of your humerus, which means there is really just enough room for the rotator cuff tendon to glide through as the shoulder moves your arm around.  The tendon can become more susceptible to impingement when something causes this space to narrow down further.  For example, muscle imbalance, shoulder joint instability, tendinopathy, spurs and labrum injury can all result in impingement by reducing clearance.

Extremely common is repetitive microtrauma associated with overhead movements.  If you are involved in sports like swimming, volleyball, baseball, tennis or work in occupations like construction, you are susceptible to shoulder pain resulting from shoulder impingment.

Once impingement is in place, the repetitive pinching of the affected tendon can lead to irritation and inflammation of the rotator cuff tendon.  This in turn can cause the tendon to thicken which can lead to worsened impingement.  It becomes a vicious cycle!

So what can you do about it?

  1. First you need to avoid the aggravating motions…you will need to stop playing your sport for a little while or somehow work around the injury while doing whatever it is that is preventing the tendon from healing.  This is probably the hardest thing for people to do but is an absolute necessity if you want to correct the problem.
  2. Identify the cause of the impingement…you may need to see a qualified health professional for this.  Someone like a chiropractor, physiotherapist, athletic trainer or sports medicine doc.
  3. Get some specialized treatment for the shoulder…soft tissue work, laser therapy, acupuncture, ultrasound…these will all enhance your recovery by improving blood flow, reducing tissue tension and decreasing inflammation and pain.
  4. Religiously work on postural improvement and correcting muscle imbalances…this will fix the poor biomechanics that contribute to reduced clearance for your rotator cuff tendon.  If you can achieve this, the likelihood of the injury recurring is significantly reduced.  Which means you can play your sport or get back to work again for the long haul!

In the case of my patient who asked me how he got shoulder impingement, the answer was fairly simple.  He was a middle-age man who had been relatively sedentary for the past 20 years, had poor posture, and embarked on a heavy weight lifting program to get in shape.  The good news is that over the past 6 months he has lost a considerable amount of weight.  The flip side is that his shoulder pain may hinder further progress…but we’re working on that now!

Got questions?  Feel free to contact your friendly neighbourhood Richmond Hill chiropractor!  I’m just an e-mail or phone call away!

Dr. Keith

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