Shoulder Impingement

Shoulder impingement is one of the more common causes of shoulder pain. Shoulder impingement occurs when the supraspinatus tendon (one of our rotator cuff muscles) gets pinched between the humerus (our arm bone) and the acromion (one of the bones in the shoulder). The supraspinatus tendon helps lift the arm up overhead. In order to do this it needs to attach in between the humerus and acromion in a specific location (see picture). There is a very small space in this area however and this tendon can get pinched in this area for a couple of reasons. One of the more common reasons is rotator cuff weakness. The rotator cuff muscles primary job is to keep the shoulder in the socket however they also function to keep the shoulder depressed in the socket. When the rotator cuff muscles develop weakness this causes the humerus to migrate up and pinch the tendon when lifting the arm overhead. If this persists for a long period of time people can develop tendonitis within the supraspinatus tendon due to repetitively pinching the tendon. Physical therapy involves mobilizing the humerus back down where it should be so it doesn't pinch the tendon, helping the tendon heal, and building rotator cuff strength to keep the humerus away from the tendon. 

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Impingement can also be caused by an abnormally shaped acromion that has a bone spur. Other genetic factors within the shoulder related to the bursa or the position of one of the ligaments called the coracoacromion ligament can also cause impingement. In this case we cannot change the shape of the acromion, or the position of the bursa or ligament in physical therapy so people are often referred to receive a procedure called a subacromial decompression. In this procedure the bone spur or the bursa and ligament are shaved down to create space within the subacromial area. The procedure can help reduce pain but people may have limitations to strength and range of motion afterwards. Physical therapy can help improve range of motion and strength after surgery. Treatment for shoulder impingement tends to get excellent results in physical therapy. Please see the photos below to see some example techniques of how we treat shoulder impingement in our clinic. If you would like to schedule an appointment please reach out to us.