Impingement Syndrome

What is Impingement Syndrome?

Well, first we have to decide what kind you have. Primary impingement is basically irritation of your rotator cuff and/or the bursa in your shoulder. The bursa is kind of like a water balloon. It’s there to cushion the rotator cuff and acts as a “buffer” between the humerus (where the cuff attaches) and the “roof” of the shoulder (the joint between your collar bone and your shoulder blade). You more than likely have pain raising your arm, reaching behind you, tucking your shirt in/fastening your bra. You don’t like to sleep on that arm either. You’ll likely find your strength is good (if you painful AND weak, you may have a torn rotator cuff). You may have recently done some painting or working overhead over the weekend and woke up Monday morning feeling it. You may have tenderness to touch in the shoulder too. Sometimes primary impingement can be caused by poor posture. Try this trick: slouch in your chair and try and raise your arm. Can’t raise it really high can you? Now sit up really tall and raise your arm. You can get it much higher can’t you (well, unless you have impingement!!). See how posture can affect this? Think of it like this: with bad posture, everytime you raise your arm, you’re basically “smashing” your rotator cuff into the roof. Think of a really tall guy in a room with low ceilings. Everytime he stands up, he’s gonna feel it. Make sense now? Primary impingement is easily treated with some exercises, postural considerations, and most of all, ACTIVITY MODIFICATION. True story: I saw a patient last week who is a semi-truck driver. Said his shoulder hurt turning the steering wheel. Sure we did exercises, but the main thing that helped this guy: raising the seat in his truck. He raised his driver’s seat higher and had no pain. He wasn’t “jamming” the rotator cuff anymore. See? Pretty easy. Was in for two PT visits and cancelled the third because he felt great. No hocus pocus there, just how it works. Remove the aggravating stimulus and magically, you feel better.

Now secondary impingement. Here, you basically have some instability in your shoulder and your humerus is “flopping” around and the cuff is getting irritated. This is a dual issue – stability and strength. Maybe you have a history of previous shoulder dislocations and subluxations. Maybe you used to be a swimmer/volleyball player/baseball player/tennis player/gymnast, working overhead a lot and just started developing activity related pain. You have similar symptoms to the primary folks. Similar treatment as primary’s. Can easily take care of this with exercise, activity modification, and most of all, strengthening in back.

The last type of impingement is called internal impingement (II). II is almost exclusively in overhead athletes – baseball pitchers, volleyball players, tennis players, javelin throwers, etc. Basically, anyone that has to throw an implement from overhead. II is tough to explain in “layman’s terms”, but basically you’ll feel an intense, deep pain in the shoulder as you are in the “late cocking” phase of throwing, which is the point your arm is at prior to coming forward. Essentially, there is “pinching” of the rotator cuff tissue. Sometimes if it isn’t serious enough, you can treat it non-operatively. However, there is usually underlying reasons for it and you may require surgery.