Impingement syndrome is a
complex injury of the shoulder. It is a common injury in overhead
throwers and athletes
participating in upper extremity sports. It may be why your shoulder is
what causes this injury, and the proper ways
to treat and prevent it can help to keep your shoulder pain free.
What is Impingement Syndrome?
Impingement syndrome is irritation of
the soft tissues of the shoulder, the rotator cuff and
These soft tissues are often
caught between the
humerus and the acromion, causing an irritation of the tissues and an
This impingement is most
common with motions
that occur overhead, or above shoulder level.
Learn more about shoulder anatomy...
Normal Shoulder Function
The shoulder is an inherently unstable joint. One look at the
articulation between the humerus and the glenoid and you can see that
there is very little bony stability. While the shoulder is referred to
as a "ball and socket" joint, the socket or glenoid is very shallow,
and does not surround the humerus. We sacrifice stability in order to
gain mobility. This allows for a greater range of motion throughout
many different planes.
Stability of the shoulder joint depends on two factors.
Static and dynamic stabilizers. The goal of both the static and dynamic
stabilizers is to keep the humeral head centered on the glenoid during
The static stabilizers are
the joint capsule, and
the areas of thickening often referred to as ligaments.
ligaments and the capsule help to hold the humeral head centered on the
glenoid. The glenoid labrum also contributes to static stability.
labrum is a ring of fibrocartilage that surrounds the edge of the
socket, and actually increases the overall depth of the glenoid by up
to 70%. This improves the contact area between the humerus and the
glenoid, increasing stability.
Dynamic stability refers to stability during
activity, and is provided by the rotator cuff muscles.
muscles all work together to keep the humerus centered in the socket
during movement and athletic activities.
function is the depression of the humeral head during overhead
This depression helps to keep the
humerus from hitting the
acromion, and impinging on the soft tissues.
There are many different factors that can contribute to impingement
syndrome. One of the most common is overuse. Athletes who participate
in overhead throwing sports can often suffer from impingement syndrome
due to overuse of the shoulder. Pitchers are especially susceptible to
As the shoulder performs
repetitive overhead movements, the
rotator cuff muscles become fatigued, and thus the dynamic stability is
As this happens, more movement of the
humeral head within the
shoulder joint occurs. As this movement increases, soft tissues between
the humerus and acromion become impinged, leading to an irritation and
This can lead to a viscious
cycle, as the
inflammation and irritation decreases the effectiveness of the muscles,
allowing for more movement and impingement, making your shoulder pain
In addition to
overuse, muscular imbalance is also another factor in impingement
muscles that attach to the front of the shoulder are much
larger and often tighter than those on the back.
and minor, subscapularis, biceps, and anterior deltoid all attach to
the front of the humerus, versus the two small posterior rotator cuff
muscles the infraspinatus and teres minor.
of this imbalance,
the humeral head is often pulled forward, and is unable to maintain a
centered position in the glenoid. If you recall, stability of the
shoulder joint relies on centering of the humeral head on the glenoid.
As this centering is decreased, effective function of the shoulder
decreases, and predisposes the athlete to injury.
In addition to stability of
the humerus and the
glenoid, stability of the shoulder blade (scapula) is also very
During normal shoulder function, the
shoulder blade rotates
on the body as you move your arm up over your head. This rotation must
occur in order for the shoulder to function properly.
there is no
bony connection between the shoulder blade and the trunk, the scapula
relies solely on muscles to keep it stable and rotating correctly.
Think about the scapula as the foundation of a
house. Without a stable
foundation, the rest of the house is likely to fall down.
true with the shoulder. Without a stable scapula, the humerus has no
base on which to attach to securely. All of these factors can
contribute to impingement syndrome.
Symptoms of Impingement Syndrome
Shoulder impingement is a complex injury, with
many different factors. However, the symptoms are similiar,
depending on the severity of the problem.
common complaint is pain and discomfort with overhead motions. In early
stages, you will have an achey pain with overhead
activities. This often subsides after the activity is finished, but may
last into the next day.
As this injury progresses, pain begins to accompany any type of
overhead motion, including daily activities like reaching up to open a
cabinet, or washing your hair.
inflammation of the shoulder
increases, impingement syndrome can lead to a loss of range of motion,
either due to pain, or a tightening of the joint capsule.
may have trouble sleeping at night,
unable to find a comfortable position. You may also have a burning
sensation that radiates into the upper arm and forearm.
There may be numbness or tingling feelings in the arm and hand.
clicking, or catching of the shoulder with movement can also be a
If you are
suffering from shoulder impingement, there are several things that can
be done in order to reduce your pain and discomfort.
aggravating activities as well as using ice several times a day, and
the use of an anti-inflammatory medication can help.
allows the shoulder inflammation to calm down by removing the
irritating stresses from the tissues. As inflammation decreases, pain
The use of ice helps to decrease inflammation, as well as reducing pain
and discomfort. However, treating the symptoms is not enough, and some
type of rehabilitation is necessary.
One of the best ways to ice the shoulder is using
an ice compression wrap. It provides
a great way to cover the entire
shoulder, without dealing with an ice bag or the mess that goes with
The compression allows for deeper penetration
of the cold. Using an
ice compression wrap several times a day can significantly decrease
Because impingement syndrome is a complex injury,
with many different possible causes, for the most effective treatment,
you should see your family physician or certified athletic trainer.
They will be able to determine the exact cause of
syndrome, and provide recommendations for treatment. In severe or
persistant cases, an injection into the shoulder may be necessary. For
those that don't respond well to rehab, surgery to decompress the
may be necessary.
impingement syndrome often
focuses on strengthening of the rotator cuff muscles and the scapular
stabilizers, as well as increasing flexibility of the anterior muscles
of the shoulder.
Capsular stretching and joint
mobilizations can also
be effective in treating impingement syndrome.
A good rotator cuff training program could be the answer to your pain
and discomfort. Sometimes, just a little guidance is all that is needed
to reverse shoulder pain and to reduce shoulder impingement.
If you are suffering from any of the above symptoms, check out
Ultimate Rotator Cuff Training Guide.
by a practicing Physical
Certified Strength and
Conditioning Specialist, it is the best home exercise program available
online to help treat your shoulder pain. Quality information is my
goal, so this recommendation isn't taken lightly.
Read my review of The
Ultimate Rotator Cuff Training Guide here
Impingement syndrome can be a frustrating and chronic injury if not
treated correctly. If you are having shoulder pain that keeps you awake
at night, or that is affecting your athletic performance, you should
seek medical help. While resting may decrease your pain, without
treating the underlying cause, return to activity will likely result in
a return of pain. Impingement syndrome often gets worse with time. So
see your physician or certified athletic trainer sooner than later.
Your shoulder will thank you for it.
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