Shoulder Pain and Impingement

Shoulder impingement syndrome is a common cause of shoulder pain. The symptoms can be pain with overhead activities, such as reaching, throwing, tennis serves, or putting clothes on. There may also be painful popping or clicking when you reach your arm overhead. Impingement can be caused by degenerative changes to muscles or bones in the shoulder and/or by shoulder instability and abnormal movement patterns of the joint.

The bony structure of the shoulder (glenohumeral joint) is inherently unstable and is the most commonly dislocated major joint in the body. Shoulder stability is due to a combination of ligaments, joint capsule, the glenoid labrum, and surrounding musculature of the rotator cuff and scapular (shoulder blade).

The cause of shoulder impingement varies from person to person. Repetitive overhead activities, either recreational (such as tennis, swimming, or baseball) or work related (such as construction, electrical work, or serving) are often contributing factors. Diagnosis of impingement syndrome can be made clinically based on symptoms, special tests of the shoulder for impingement, and, if necessary, diagnostic imaging to evaluate bony or structural changes in the shoulder.

Treatment for impingement syndrome has two primary phases. The first phase is to decrease pain and inflammation and the second phase is to change and restore the mechanics of the shoulder.

Initial treatment may include rest, anti-inflammatory medications, physical therapy modalities, and avoidance of aggravating activity. Low level laser therapy is also very effective to decrease the pain and inflammation.

Restoring the appropriate mechanics of the shoulder is achieved by an individualized program to strengthen the muscles of the shoulder and shoulder blade. Stretching short and tight muscles and joint mobilization may also be included in this phase of rehabilitation. Working to correct muscle imbalances of and surrounding the shoulder will allow the joint to again move in the ideal pattern and decrease the stresses on the irritated and impinged structures. By receiving the proper treatment most of the pain from shoulder impingement can be eliminated and can help reduce your risk for shoulder surgery in the future.

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