Impingement syndrome, or subacromial impingement syndrome, is one of the most common shoulder impairments. It can be caused by degeneration of or overuse injury to the rotator cuff tendons and bursae. The rotator cuff tendons and subacromial bursa lie between the bones that comprise the shoulder. The rotator cuff tendons and subacromial bursae occupy a small area between the humerus and scapula called the subacromial space. If swelling and hemorrhage occur secondary to repetitive activity or injury, compression of the tendons in this space may occur. This can lead to intense pain when reaching up overhead to put on a shirt.
Other factors that may cause impingement include improper posture, muscle imbalances, bone structure, bone spurs, or other shoulder pathology such as glenohumeral instability. It is likely that a combination of these factors causes impingement syndrome.
Impingement syndrome is characterized by an insidious, slow onset of pain and functional limitations. Pain is typically felt at the top or front of the shoulder where the rotator cuff tendons join the upper arm bone. The pain may occur at rest but typically occurs with provocative activity such as reaching overhead into a kitchen cabinet or reaching behind the back to put on a coat.
Symptoms of Impingement Syndrome
shoulder pain at top or front of a shoulder at rest or with activity
pain that occurs prior to end range of motion
difficulty reaching behind the back or overhead
potentially limited passive range of motion or the ability for someone else to move an arm
difficulty performing daily, functional tasks
Goals for Physical Therapy
control inflammation and promote healing
increase range of motion
increase shoulder muscle strength, specifically the rotator cuff and other shoulder stabilizers
Physical therapy can assist in treatment for shoulder impingement syndrome. Treatment includes various techniques that address impairments. Cross friction massage and modalities like electric stimulation and ultrasound are used to promote healing, reduce pain, and control inflammation. Cautious, progressive manual and active stretching is performed to increase tissue flexibility without provoking impingement pain. Therapeutic exercise is performed to develop muscle strength and muscle balance in the rotator cuff muscles as well as the scapular stabilizers of the upper back. Proper postural habits are reinforced during exercise to promote postural awareness.
The majority of people with impingement syndrome are treated successfully with physical therapy, medication, and/or temporary avoidance of repetitive overhead activity until symptoms subside. Typically impingement symptoms subside within 2-6 months. If symptoms persist, further diagnostic testing may be performed by a physician to rule out a full-thickness rotator cuff tear or other shoulder pathology.
By Quiana P. Roberts, PT, DPT
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