Shoulder Impingement Pain Rotator Cuff Injuries Subacromial Bursitis

The shoulder joint's stability depends on the complexity of muscles and ligaments that surround it.  Shoulder impingement pain occurs when structures (such as rotator cuff tendons or subacromial bursa) are pinched in the subacromial space, between the ball of the shoulder joint, and the shelf of bone above (the acromion).  

When tissues are damaged they become inflamed, which increases the pinching effect and creates pain as a result.  The pain is usually worse when the arm is lifted to or above shoulder level, and sometimes when the shoulder is rotated.

The Rotator Cuff Muscles

The subscapularis, supraspinatus, infraspinatus and teres minor are small muscles situated close to the ball-and-socket shoulder joint (glenohumeral joint).  Collectively, these four muscles are known as the rotator cuff.  Although they have individual actions, their main role is to work together to stabilize the ball within the socket of the shoulder joint.  They can be injured either by a single incident, or by repetitive strain.   Symptoms of rotator cuff injury typically include weakness, loss of full movement and pain.  

3 Common Types of Shoulder Impingement:

Primary Impingement  

Due to a small subacromial spare, this can be pre-existing, due to past shoulder injury or osteoarthritis.

Secondary Impingement

Due to shoulder laxity or instability.  This can be because they are naturally hypermobile, caused by an injury, or occurring over time due to repetitive overhead activity, poor posture or inactivity.  Due to this instability, the rotator cuff will become weak and tired, and will not effectively prevent the ball of the shoulder joint from squashing up against the arch.

Overstraining

During forceful or repetitive throwing, or repetitive or loaded overhead activity the rotator cuff muscles must work very hard, and is prone to overload.

Medical Assessment & Treatment

Your GP will do a physical assessment and may order a diagnostic ultrasound to clarify the structure and degree of injury.  In some cases, a corticosteroid injection, or a surgical opinion is warranted in addition to physiotherapy.  Injections give a window of opportunity (usually 4 weeks or so) to start physio rehabilitation without pain being a limiting factor, and shouldn't be considered a cure.

Your GP may also prescribe pain killers, or anti-inflammatories.

Physiotherapy Assessment & Treatment

A physiotherapist skilled in shoulder assessment will:

• Ask questions and do a thorough physical assessment to diagnose which structure/s are involved and assess which contributing factors are most relevant to your injury.
• Encourage you to avoid overhead or aggravating activities, use ice, and give practical advice
• Use taping, a sling or a brace to unload the damaged structures
• Release tight muscles that compress the subacromial space.
• Assess your neck and other nearby anatomy to ensure they are not contributing to the pain, and treat them if they are affected.
• Teach you good shoulder posture and patterning to relieve pain, and as a base to start working from with exercises.
• Prescribe gentle, individualised exercises to improve posture, control and strength around the shoulder blade and socket. It is important that these should always be 100% painfree. Please speak with your physio immediately if they cause any discomfort or aching during or afterwards.
• Gradually and safely progress your exercises and check your technique to help you to return to normal, pain-free activities, work and sports.

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