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Shoulder Impingement

by Cathy Richey and Mark Lamendola

Shoulder impingement, more properly called "impingement syndrome," happens when the bones and tissues in your upper arm or shoulder are not aligned correctly. The misalignment narrows the space around which the muscles of your shoulder move.

This is often accompanied by inflammation and swelling, which exacerbate the main symptom: pain when you move your shoulder. And sometimes, pain even when you don't.

Left untreated, shoulder impingement can lead to serious problems that even surgery can't fix.

Fortunately, treatment can solve the problem if applied early enough. Even more fortunately, you can reduce the likelihood of the condition if you know what to do. Toward that end, you need to know the risk factors and causes.

 

Risk Factors

Impingement is common in young athletes, due to overuse, overtraining, impact, poor nutritional habits, and other contributors. Young athletes who use their arms overhead for swimming, baseball, and tennis are particularly vulnerable.

Those who do repetitive lifting or overhead activities using the arm, such as paper hanging, construction, or painting are also susceptible.

It's also common in older adults, though for mostly other reasons. Improper exercise by middle-aged men trying to pretend they are young, lack of exercise, poor posture, and poor nutrition are some of the behaviors that lead to this problem.

Regardless of age, pain may develop as the result of minor trauma. It may occur suddenly and viciously, with no apparent cause. But, there is a cause.

 

Causes

These are some causes of shoulder impingement (definitions are below):

  • Acromioclavicular joint arthritis.

  • Calcified coracoacromial ligament.

  • Structural abnormalities of the acromion and weakness of the rotator cuff muscles .

  • Repeated actions that irritate the shoulder.

  • Weakness in the shoulder and shoulder blade muscles.

  • Normal wear and tear with aging.

  • Poor head and shoulder posture.

  • Acute injury, such as impact or sudden tugging. This type of injury is most likely to occur in a shoulder that hasn't been properly conditioned.

 

Symptoms

How do you know if you have shoulder impingement? Self-diagnosis has a low accuracy rate, so facilitating that isn't our intention here. Our intention here is to help you see the signs that you have a problem that requires you to change what you are doing. And change right away. Here are some symptoms:

  • Minor pain that is present both with activity and at rest.

  • Pain radiating from the front of the shoulder to the side of the arm.

  • Sudden pain with lifting and reaching movements.

Impingement commonly causes local swelling and tenderness in the front of the shoulder, but not always. The problem may result in tender tissue that hurts to the touch, but not always. You may feel pain when you lift that arm, and/or you may feel pain when you lower it.

The cost of doing nothing

When confronted with pain, most people will take some aspirin or some other pain reliever and continue with business as always. That's not how you handle shoulder impingement. Your shoulder is alerting you to a problem that can quickly get worse. Much worse.

As the problem progresses, there may be pain at night. Strength and motion may be lost. It may be difficult to do activities that place the arm behind the back, such as buttoning or zippering.

In advanced cases, loss of motion may progress to a "frozen shoulder." All movement may be limited and painful.

At this point, most folks will head to the doctor. Though it's not too late to prevent permanent damage, your activity level will have to be severely curtailed. Had you taken action at the onset, you would likely have had full recovery in one to three weeks. Now, you are looking at several months. Bone spurs may have developed, and surgery is very likely even if they haven't.

At this point, popping pain relievers and hoping the problem will go away is a ticket to permanent damage including painful arthritis.

So, what can you do at the onset to head off this bleak scenario? Let's take a look....

 

Treatment

Perform these steps in this order:

  • Ice the shoulder until it feels numb. Place ice in washcloth, don't apply ice directly to skin. Do this at least three times a day for 24 to 48 hours. This slows everything down and helps reduce swelling and inflammation. Application of ice this way is standard protocol.

  • Anti-inflammatory medicines. Don't take aspirin. Hardcore athletes have a saying, "Ibuprofen is my friend." That is an anti-inflammatory pain reliever (common brand is Advil).

  • Rest. Try not to move the shoulder that has the problem, except to do gentle stretches. The less often and less intensely you irritate the tendons involved, the faster the condition will go away.

  • Exercise to stretch and strengthen. Exercise the other shoulder. If you have been doing heavy bench presses (a common cause of this), stop benching at all. Do a dumbbell fly with the other arm. Exercising the good arm will prevent atrophy in the injured one. Be sure to do your squats or deadlifts twice monthly as usual, to maintain the correct hormonal balance.

Most people think rest means "don't use it." Read those last two bullet points (above) again. And, here's more on that topic.

The current thinking can be summed up as "use it or lose it." In the past, for example, you might have been told to keep your arm in a sling for weeks. Physical therapists make it their top priority to "get you going" again as soon as possible. Why? Because keeping the shoulder immobilized causes the muscles to weaken and atrophy; furthermore, immobilization weakens bones and joint cartilage, and promotes soft-tissue scarring.
[Source: www.apta.org]

 

 

Prevention

You should be exercising your shoulders on a regular basis, allowing a minimum of 96 hours between shoulder workouts for the muscles to properly recover. The shoulder consists of three muscle groups. It is critical you work the rear deltoids. Failure to do this will result in an unstable shoulder. Even if you never exercise the other two groups directly, work those rear delts.

Go into any gym, and nearly everyone working shoulders is doing a counterproductive workout. Here are some tips:

  1. Stay off the exercise machines. This isn't open for debate. You do not get fit using those machines. But, you do create muscle imbalances. Use free weights with proper form, and your muscles will have no choice but to respond with proper development. You cannot do this with machines. They are great for physical therapy or for getting started after years of being sedentary. But after 90 days they have outlived their usefulness.

  2. Never do shoulder presses behind your neck. This is an unnatural motion that puts your joints out of alignment.

  3. Don't do lots of repetitions. Many people count out 8 to 12 repetitions per set, do three sets, and claim to have worked out. They haven't. See our article on intensity.

  4. Watch your posture at all times. Keep your shoulders lined up.

  5. When doing the bench press, try to pinch your shoulder blades together. Most men do this exercise with shoulders pronated, meaning they are using their front delts. The typical guy has to reduce the weight by half or better when made to do this exercise safely and productively. The good news is, if you set your ego aside for a few weeks you will see massive development in your pectorals because you will be working them for a change. And you won't be screwing up your shoulders in the process.

  6. Get an illustrated book on weightlifting. Review the shoulder exercises carefully, and pick one or two to use for a few workouts. Don't do all of them in one workout. Learn proper exercises to stretch and strengthen your rotator cuff tendons and shoulder muscles. It is not at all important to see how much you can heft overhead while arching your back and using momentum. It is very important that you develop a strong and stable shoulder that nicely fills out your shirt. Same goes for women.

In sports-related activities, learn proper technique to prevent painful and expensive shoulder problems. [Source: www.drkoop.com]

 

Terms Explained

A couple of the words used earlier are a real mouthful. Here's what they mean:

  • Acromioclavicular joint: The acromioclavicular joint, or AC joint, is located between the acromion (a projection of the scapula that forms the point of the shoulder) and the clavicle (the collar bone). This is a gliding type of joint.

  • Coracoacromial ligament: The heavy arched fibrous band that passes between the coracoid process ( bony process on the shoulder blade) and the acromion above the shoulder joint.
   

 

 

 

About Cathy (one of the authors): Cathy and her Doberman Trooper conduct research into all kinds of topics and produce articles like the one you see here. To contact Cathy, write to thecathyfactor@yahoo.com. Get the facts from Cathy, and let the Cathy Factor give you an edge.

 

 

 

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