My shoulder is painful right on the top of the bone & I am struggling to lift my arm without pain.
Is this shoulder impingement?
On top of the shoulder there is a space called subacromial space. It is normally occupied by a group of four tendons called the Rotator Cuff, that are responsible for controlling the shoulder joint through all movements of the shoulder. Shown here is the shoulder joint along with a small sac of fluid called a bursa that decreases friction.
If for some reason the space is reduced, the rotator cuff tendons and bursa will be intermittently trapped or compressed during shoulder movements, causing a shoulder impingement. This can present as a bursitis and/or rotator cuff tendinopathy depending on the main tissue affected/injured.
Understanding shoulder pain
Shoulder impingement usually occurs over time due to repetitive overhead activity, trauma, previous injury, poor posture or inactivity.
Impingement can occur if you have an unstable shoulder or poor scapular patterning through normal movements. This means that there is a combination of excessive joint movement, poor shoulder blade control, ligament laxity and muscular weakness around shoulder.
The main symptom is shoulder pain that can extend from the top of the shoulder to the elbow. The most common painful movement is lifting the arm overhead. Further, when lying on the shoulder, reaching actions like the seat-belt, putting the hand behind the back of the head can be painful too. The condition can present with some muscle weakness related with lifting and reaching movements as well.
Before the treatment starts it is crucial to understand how the impingement occurred, as aspects like static and dynamic posture, muscle strength, flexibility and spinal shape have important roles on the treatment pathway. This is to make sure you receive the most effective management for your specific situation.
At the early stages it is important to protect the area, address the pain and decrease the inflammatory process. Initial treatment should regain full range of motion in the shoulder and address all the articular and soft tissues restrictions present, while equally beginning to retrain the deep stability muscles to work more effectively.
The rehabilitation process should continue with work on the shoulder blade control and rotator cuff strength to achieve the best long term results. Finally high speed, power, proprioception and agility should be restored in order to return to sport or specific activities a person wants to achieve.
If conservative methods fail to reduce the pain and inflammation, corticosteroid injections can be useful, however it is important to note that once the pain settles, it is important to work on strength, flexibility, neck and thoracic spine involvement plus scapulohumeral control to ensure the shoulder impingement does not return once the injection has worn off.
Look after your body and it will look after you. Don’t ignore pain, and don’t assume because pain has settled the problem is resolved. The research is very clear that the biggest predictor of an injury is a previous injury!