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Do you get pain when lifting your arm above your head or to the side? Is it uncomfortable to reach behind your back? Are you unable to lie on your affected shoulder when sleeping? These are signs that you may have impingement of your shoulder!
Shoulder and upper arm pain is one of the most common presentations we see as physiotherapists. This is due to the shoulder being one of the most moveable joints in the body.
A quick bit of shoulder anatomy!
The shoulder is made up of the head of the humerus (i.e. the top of the upper arm bone) and a shallow groove on the outside of the shoulder blade. This is what makes up the shoulder joint. Above the shoulder joint there is another bone which comes off the shoulder blade called the acromion. The area between the shoulder joint and the acromion is called the subacromial space, and there are various structures which run through this space including one of the rotator cuff tendons (the group of muscles that hold the shoulder in its socket) and a bursa (a small fluid sac which cushions the rotator cuff tendon). When we raise our arm up or to the side, the subacromial space narrows, however there is still room for the tendons and bursa. This is not the case with shoulder impingement.
What is shoulder impingement?
Shoulder impingement is where there is pinching of the rotator cuff tendon or bursa between the shoulder joint and the acromion. This is what causes your pain when lifting your arm up. Shoulder impingement is not a condition, rather a consequence of another underlying problem.
Things that can cause shoulder impingement include:
– Problems with your rotator cuff muscles, such as weakness, a tear or general overuse
– Weakness of the muscles that control your shoulder blade, which can alter how your shoulder works
– Tightness of the muscles around your shoulder and shoulder blade
– Instability of your shoulder (i.e. the ligaments around your shoulder are stretched which results in you having more movement than normal)
– Poor posture (i.e. having a slouched upper back or your chin poking forward)
Things you can do to help:
– Try to limit the stress on the rotator cuff tendons. You can do this by avoiding any activities or movements which cause your shoulder pain. This will allow the tendons to heal.
– See your physiotherapist! Because there are various factors which can cause impingement, it is important to identify the exact cause which is resulting in your pain. A physiotherapist will be able to do a thorough assessment to identify these dysfunctions, and will then be able to treat the cause of the impingement.