Shoulder Impingement

If sharp pain occurs during exercise or activities of daily living, stop what you're doing! Discuss the situation with your doctor or physical therapist. These specialists can help you understand why you're at risk, and what you can do to minimize the damage to your shoulder.

Shoulder impingement is the pinching of a tendon or bursa (a fluid-filled sac or membrane in a joint). The condition can be caused by:

• Anatomy. The shape of the bones in your shoulder or the presence of a bone spur in the shoulder may be the problem.
• Muscle weakness. The shoulder muscles known as the rotator cuff, and the scapular stabilizers in the mid-back can cause improper movement of the shoulder and produce pinching of the tendons or bursae.
• Shoulder instability also leads to impingement.

Signs and Symptoms
You may be able to identify shoulder impingement or bursitis as a sharp pain in the front or top of the shoulder while performing certain overhead movements. Simple activities such as reaching into a cupboard, reaching for a seat belt, washing your hair, can become very painful as a result. Sleeping can be most uncomfortable, even on the opposite side from the injury.

Risk Factors
Among risk factors are repetitive shoulder motions, which can cause the muscles of the rotator cuff and shoulder to become fatigued. This leads to improper functioning of the shoulder muscles and eventual impingement. Poor posture can also make impingement more likely.

Diagnosis
Your doctor may ask you to move your shoulders in all directions and note where you feel pain. A physical therapist will help determine the cause of the impingement and educate you on how to avoid future pain. This may include exercises to improve posture and increase the strength of muscles in the shoulder and shoulder blade. Ice, electrical stimulation or ultrasound may help decrease pain and encourage healing.

Outlook
The outlook for improvement will depend on how long you have been experiencing pain. Patients can return to full activity when they can discontinue the use of anti-inflammatory medication without the return of pain. Another key is a demonstrated improvement in strength with normal range of motion. Your physical therapist can help you gradually introduce normal activities into your rehabilitation program.

In some cases that are refractory to conservative treatment efforts, surgery may be indicated to correct the underlying problem.