What is Impingement Syndrome of the Shoulder?

Impingement syndrome is a common shoulder condition seen in aging adults. This condition is closely related to shoulder bursitis and rotator cuff tendonitis. These conditions may occur alone or in combination.

In most parts of the body, the bones are surrounded by muscles. In the shoulder region, however, the muscle is surrounded by bone. If one taps on the top of the shoulder, bone can be felt immediately under the skin. Underneath that bone is the muscle that lifts the arm. The rotator cuff muscles of the shoulder are sandwiched between the arm bone and the top of the shoulder (acromion). This unique arrangement of muscle between bone leads to the condition of impingement syndrome (shoulder bursitis, rotator cuff tendonitis).¹

Symptoms of Impingement Syndrome of the Shoulder

The typical symptoms of shoulder impingement syndrome include :

• difficulty reaching up behind the back,
• pain when the arms are extended above the head,
• and a weakness of shoulder muscles.

If shoulder muscles are injured for a long period of time, the muscles can actually tear in two. The resulting injury is called a rotator cuff tear. This causes very significant weakness and, on occasion, inability to elevate the arm against gravity. Some patients will have rupture of their biceps muscle as part of this continuing impingement process.²

Causes of Impingement Syndrome of the Shoulder

Impingement Syndrome, which is sometimes called Swimmer’s shoulder or Thrower’s Shoulder, is caused by the tendons of the rotator cuff (supraspinatus, infraspinatus, teres minor and subscapularis muscles) becoming irritated and inflamed as they pass through a narrow bony space called the Subacromial Space – so called because it is under the arch of the acromion.

This can lead to thickening of the tendon which may cause further problems because there is very little free space, so as the tendons become larger, they are impinged further by the structures of the shoulder joint and the muscles themselves.³

When an injury to the rotator cuff muscle occurs, the muscle responds by swelling much the way an ankle does when it is sprained. However, because the rotator cuff muscle is surrounded by bone, its swelling causes a number of events to occur. The pressure within the muscle increases, resulting in compression and loss of blood flow in the small blood vessels called capillaries. When the blood flow is diminished, the muscle tissue begins to fray much like a rope. As the muscle tissue swells, it results in the classic features of a pain characterized like a toothache. Pain is aggravated by actions such as reaching up behind the back and reaching up overhead. Night pain resulting from this shoulder condition may result in sleep interruption.⁴

Treatment / Prevention of Impingement Syndrome of the Shoulder

WRT160N

Massage Therapy

Sports Massage / Injury Specific Techniques performed by the skilled therapists at Advanced Alternatives Massage Therapy have proven to be effective by encouraging the reduction of edema in the area. Addressing Trigger Points and reducing pain referral patterns help to relieve the discomfort associated with soft tissue injury. Gentle realignment of the surrounding fascia by using Myofascial Release techniques (MFR) can help restore pain free range of motion.

Your doctor may advise strengthening exercises. Physical therapy, ultrasound, moist heat and electrical muscle stimulation are also recommended.

Sources:

1. http://www.sportsinjuryclinic.net/cybertherapist/front/shoulder/impingment_syndrome.htm
2. http://www.sportsinjuryhandbook.com/injuries/index.html
3. http://www.clevelandclinic.org/health/health-nfo/docs/1700/1707.asp?index=7079&src=newsp
4. http://www.clevelandclinic.org/health/health-info/docs/1700/1707.asp?index=7079&src=newsp