Shoulder impingement, also known as swimmer’s shoulder, is a common complaint seen in repetitive overhead sports such as baseball, softball, volleyball and crossfit. You also do not have to be an athlete to experience pain associated with shoulder impingement. It is possible to have pain during daily activities such as reaching overhead to put dishes away in a cabinet or even putting on a coat.

What is shoulder impingement?

Shoulder impingement occurs when the subacromial space which is the space between the acromion of scapula (shoulder blade) and the top of the humerus narrows when lifting an arm overhead either in flexion or abduction (out to side). The majority of the time it is the supraspinatus tendon and/or subacromial bursa that are vulnerable to being compressed, as shown in the image on the right.

So what are common symptoms?

Characteristically, you will have pin-point pain either at the top of or in front of the shoulder when bringing arm out in flexion or abduction. You may also experience referred pain down the affected upper arm when performing these arm motions. Is this pain inherently bad? Not necessarily, but think of the pain as a check engine light on your vehicle dashboard. Just because the check engine light is lit does not always mean something disastrous is happening; however, just like you would take your car into a mechanic for a check up, the same can be applied for your shoulder pain.

At home tests that you can perform:

In the pictures provided above, it is the patient’s right arm being tested.

 Test 1 – Start with your hand on opposite shoulder with elbow near your side, then lift elbow toward ceiling while maintaining hand on opposite shoulder.

 Test 2 – Bring your arm straight out in front of you to 90 degrees or parallel with the floor, bend at the elbow another 90 degrees with palm facing floor and then take other hand and provide downward pressure on the wrist while resisting with the arm being tested.

If pain is noted while performing any of these tests, your first line of defense is to contact our office or another chiropractor/physical therapy clinic to schedule an appointment for proper examination, diagnosis and treatment. It is important to know location and quality (sharp, dull, ache, deep, etc) of your pain as this is something we will ask during your examination which gives us a better idea of the anatomy involved.

Pain in these tests doesn’t necessarily mean you have shoulder impingement as there are many other factors that play a role because the shoulder is one of the most intricate and mobile joints in the human body. Each part has a key responsibility in either helping with stability, mobility or a combination of both.

What could be the cause?

 A muscle strength imbalance is one of the more common reasons shoulder impingement occurs. This does not mean that we need to lift more in terms of getting all muscles stronger, but more along the lines that there needs to be a balance between shoulder stabilizers and prime movers. In addition to proper muscular balance, adequate coordination of movement between the shoulder blade and humerus is needed. In other words, how your shoulder blade and arm move together when performing certain movements is important.

Treatment and How We Can Help

Typically, shoulder impingement responds favorably to conservative management.

-        Spinal adjustments, particularly of the upper thoracic spine, are utilized. Proper extension of our upper back is needed as helps with the last bit of shoulder flexion.

-        Soft tissue therapy is also utilized decrease tension in tight or stiff muscle groups.

-        Exercises to strengthen scapular stabilizers are given in office and as take home exercises.

Of the few cases that do not respond to conservative care, imaging may be requested to look for possible structural changes that could be hindering progress. If we are not making the changes that we would like, we will work together to develop a plan for the next course of action.

We hope you found this information beneficial and if you have any questions or concerns, do not hesitate to reach out and make an appointment at Focus on Health!

 -        Jake Curran, Chiropractic Intern

Reference

 Shoulder Impingement Picture

https://www.dreamstime.com/shoulder-impingement-illustration-showing-image234236613