Shoulder Impingement

When a tendon is irritated, swelling and inflammation is triggered. This can come in various forms such as mild tendon inflammation (tendinitis), bursitis (inflamed bursa/joint padding), calcific tendonitis (bone forming within the tendon), and can even lead to a partial or full thickness tendon tear. Over time the tendons can thicken due to repeated irritation. A thicker tendon in turn finds it harder to travel through narrow spaces, exacerbating the problem further. Over time, tendons can gradually show wear and tear with decreased circulation within the tendon.

Shoulder impingement generally occurs due to repeated overhead movements of your arm:

• Exercise/athletics activities such as swimming or throwing – poor technique, or trying too hard will, affect coordination.
• Home activities such as hanging out the wash, reaching up into cupboards or DIY.

Other possible causes include:

• Trauma – for example falling onto the arm
• Osteoarthritis – this can cause bony growths on the joint surfaces.
• Poor posture – rounded shoulders is another big cause. When the shoulders come forward, the bones have shifted their position slightly and tendons are now moving from a different angle which can cause them to catch between bones when lifting up the arms.

Pain is the main symptoms you will experience, generally when lifting your arm above shoulder height. Day-to-day activities such as reaching up behind your back, brushing your hair, or reaching for a seatbelt can also be very painful. Pain is often felt on top or at the front of the shoulder and can travel down the upper arm towards the elbow. Sleeping can also be very challenging, with many people experiencing pain at night regardless of which side they sleep on. If the condition continues to worsen, you might start to experience pain even when you’re just resting.

Treatment will ultimately depend on what has caused the problem. Initially, treatment will focus on helping to reduce pain and increase shoulder mobility. Once range has improved, the focus will shift to strengthening weak muscles and improving co-ordination to ensure muscles are switching on at the right moment. 

Some shoulder impingements will respond very well to treatment, but others can be more stubborn and frustrating, taking between 3-6 months to resolve. There is no specific time frame for when to progress from each stage to the next.