Shoulder impingement syndrome is caused by the tendons of the rotator cuff muscles becoming impinged as they pass through a narrow bony space called the subacromial space. The subacromial space is so called because it is under the arch of the acromion. With repetitive pinching, the tendons become irritated and inflamed.

This can lead to thickening of the tendon, usually the supraspinatus tendon, which may cause further problems because there is very little free space. As the tendons become larger, they are impinged further by the structures of the shoulder joint and the muscles themselves.

Impingement Syndrome in itself is not a diagnosis, it is a clinical sign. There are at least nine different diagnoses which can cause impingement syndrome which include bone spurs, rotator cuff injury, biceps tendinopathy, arthritis and scapula dysfunction. If left untreated, shoulder impingement can develop into a rotator cuff tear.

The supraspinatus muscle is probably the most commonly involved in impingement syndrome of the shoulder.

Shoulder impingement is classified as internal or external depending on the causes.

External impingement is divided into primary (caused by a bony spur or trauma) and secondary impingement, the result of poor stabilisation of the shoulder joint.

It is thought shoulder impingement syndrome begins as an over use injury of the supraspinatus tendon which runs along the top of the shoulder blade. Some occupations or sports have an increased likelihood of developing impingement of the tendons such as swimmers and painters.

Pain then causes dysfunction of the rotator cuff muscles which causes the upper arm bone to shift slightly and possibly also result in inflammation of the bursa or small sack of fluid (subacromial bursitis).

Over time the pain causes more dysfunction and impingement in a vicious circle which may eventually lead to ossification or bony spurs growing and causing injury to the rotator cuff tendons and so on. So it is vitally important that impingement syndrome is rested and treated as soon as possible to avoid longer term damage.

The main complaint is one of pain, often felt on the outside of the upper arm. A classic presentation is of a painful arc on movement when the arm is lifted out to the side and up to your ear. This corresponds with the narrowing of the sub-acromial space.

Pain is also commonly felt on twisting movements such as putting on a bra or cardigan. When the inflammation is active, you may experience pain at night and when your arm is resting. Sometimes people describe a ‘locking’ sensation in the arm on certain movements. 

Symptoms of neck, shoulder, upper arm or hand pain including pins and needles should be described to your doctor during examination as these may indicate other conditions such as cervical neck injury, thoracic outlet syndrome or brachial plexus injury.

Avoid things that make the pain worse or activities that involve repeatedly lifting your arm above your head (such as swimming or playing tennis) for a few days or weeks. 

Don't stop moving your arm completely and try to carry on with your normal daily activities as much as possible so your shoulder doesn't become weak or stiff. It's usually best to avoid using a sling.

Hold an ice pack (or a bag of ice cubes or frozen vegetables wrapped in a towel) to your shoulder for around 20 minutes several times a day.

Take painkillers – anti-inflammatory painkillers (such as ibuprofen) or paracetamol may help. Your GP can prescribe stronger painkillers if needed.

Perform some gradual shoulder stretches and exercise to build up strength in the rotator cuff muscles.

Treatment at Hand Kinetics includes exercises to strengthen the muscles around your shoulder blade, improve your posture, stretching exercises and/or strengthening the rotator cuff. 

Although the exercises may be hard work, tight or uncomfortable, they should not be painful. If you are unable to do any form of exercise because of pain, we can offer treatments such as ultrasound, thermal therapies and acupuncture. 

It is really important to learn ways to break the pain cycle with shoulder impingement as disuse of the shoulder can cause complications. At hand kinetics we assess the whole person to ensure the goals of treatment are tailored to your individual needs with emphasis on return to functional activities.