Why can’t I raise my arm above shoulder height? It could be a condition called shoulder impingement. The presentation of this problem includes shoulder pain when trying to lift the arm sideways away from the body. Pain develops at or about 90°. This maneuver pinches or compresses the rotator cuff tendons between the acromion (part of the shoulder blade) and the head of the humerus or upper arm bone. There may be a painful arc from about 70° up to 130°. This article addresses a conservative approach in the care and treatment of shoulder impingement syndrome.
Normal shoulder abduction or moving the arm away from the body.
The shoulder “humps up” with the impingement and raising the arm above 90 degrees may be impossible. In this picture it’s painful and restricted at 45 degrees.
What is the Cause of Shoulder Impingement
Shoulder impingement is the compression of the rotator cuff tendon between the head of the humerus or the upper arm bone and the acromion or part of the shoulder blade. This can originate from trauma or repetitive strain to the rotator cuff. Many times the patient cannot recall any one specific incident or trauma yet the problem develops. There are other conditions that can contribute to shoulder impingement. These include:
- Congenital Development – Bones around the joint such as the shoulder blade, humerus or collar bone have not developed properly.
- Non-Union of a Fracture – The bones do not grow back together.
- Degenerative Bone Spur Formation – Undersurface of acromion on shoulder blade.
- Post Surgical – Calcific tendonitis may develop from surgical trauma and a thickening of the tendon occurs.
Shoulder impingement is marked by limited overhead or even above shoulder height work ability. It’s painful at night when sleeping on the affected side. There is no radiation of pain down the arm or sensory loss.There are physical examination tests your doctor will perform to confirm if the shoulder impingement is present. This problem may develop into bursitis, degenerative tears in the rotator cuff or tendinopathy/tendonitis.
Conservative Management of Shoulder Impingement
Conservative management is the first step in the care and treatment of shoulder impingement. Treatment may include the following:
- Ice or Cryotherapy – Ice helps to reduce the swelling of the tendons and surrounding soft tissue. Heat should be avoided initially as it produces an increase of fluid to the area and is counterproductive.
- Ultrasound – This treatment aids in the relief of soft tissue swelling and promotes healing.
- Electrical Muscle Stimulation – It is designed to help reduce muscle spasm, provide relaxation of the muscle and assist in reduction of pain.
- Shoulder Manipulation – Chiropractic mobilization of the glenohumeral joint and possibly the scapulo-costal (shoulder blade). This includes traction/distraction type techniques.
- Modification of Activities of Daily Living – Try to reduce or eliminate actions or movements that cause stress or strain to the shoulder. Avoid working above shoulder height. Place your hands below the 3 and 9 o’clock positions on the steering wheel to help reduce pain in the shoulder.
- Rotator Cuff Exercises – Stretching and strengthening exercises should be started once the acute pain begins to subside.
- Average Length of Treatment – It’s possible that treatment may take up to 4-6 weeks. Self care is an essential part of the recovery process. Failure to participate with home recommendations may slow the recovery or prolong and potentially allow it to progress adversely.
- Medications and Injections – Recommendations for medications or injections is beyond the scope of this article. These protocols are implemented if conservative management has failed.
Suggestions for Home Care
Many shoulder impingement problems can be managed conservatively. To minimize office care, cooperation with home recommendations is necessary. The following suggestions are designed for home care. These include:
- Initially, do not perform throwing actions or do any overhead activity that aggravates the pain.
- Modify activities of daily living to include work and recreation. Athletic or sport activities that do not aggravate the pain can be continued. Working with your employer for ergonomic or jobsite changes may be necessary.
- Ice may be needed intermittently during this time frame. Always enclose the ice in a bag and place a towel around the ice bag to protect the skin. This area is very superficial and ice should not be left on the site for more than 8-10 minutes. A two hour period between applications is reasonable.
- Should a low level of symptoms continue, rotator cuff exercises should be maintained on a daily basis.
Participating in the care and treatment of your shoulder impingement will assist in your recovery. There are occasions when this condition will require more aggressive treatment.
The doctors at Coon Rapids Chiropractic Office have experience in the conservative care and management of shoulder impingement.