The shoulder is a special “ball and socket” joint which by design allows for much mobility in multiple directions but has limited stability. The bone in the upper arm is called the humerus and at the top end of the humerus, there is a partial ball called the humeral head. The shoulder blade (scapula) is a flatter shaped bone that is held onto your upper back’s rib cage by muscles. The top outside section of the scapula has a partial socket shape and accepts the humeral head. The collarbone (clavicle) also provides support to the shoulder complex. The shoulder joint has a surrounding capsule that helps hold it together and the inner lining of the capsule produces the joint’s fluid for lubrication.
The rotator cuff is a set of 4 muscles that originate on the scapula and run to the upper part of the humerus. This group of muscles work together to help control the movement and add to the stability of the ball in the socket. One of the rotator cuff muscles is called the supraspinatus and its tendon runs through a tunnel formed by the top portion of the scapula above the socket called the acromion to the top of the humerus. Arthritic changes or a certain shape/formation of the acromion can occupy some of the space and can pinch the supraspinatus tendon during movement causing swelling or fraying. If the supraspinatus tendon is swollen or weakened, the coordination of the rotator cuff complex is disturbed. When any of these situations occur, the supraspinatus tendon and/or its associated bursa (fluid filled) sac will get “impinged” (pinched) against the acromion typically around 90 degrees of raising your shoulder in front or out to the side of the body. This condition is typically progressive from a mild inflammation to a fraying with different degrees of tearing of the supraspinatus tendon.
Since impingement syndrome typically starts as a mild occasional pain and can be avoided by limiting certain motions, most people let it go until it advances to a moderately or greater pain level and functional limitation. Pain will routinely be present reaching over shoulder height and reaching behind your back so people will limit these motions. If the motion is avoided longer term a frozen shoulder can develop which is a tightening of the shoulder joint capsule and this causes even more limits of movement for the arm.
Impingement syndromes regularly resolve with physical therapy. A physical therapy evaluation will assess the current limitation, the strength of muscles, and the mechanics of the joint motion. If sports participation (such as throwing sports or weight lifting/body building) is involved, assessment of sports participation may be needed and temporarily modified. Work tasking may need discussed along with work modifications until the condition resolves. Other contributing factors can include age, history of diabetes or osteoarthritis or previous history of injury or cuff repair. Treatment is initiated to reduce pain and the inflammation process, restore proper joint mechanics with manual treatments by the therapist, and to improve muscle strength and coordination (training the muscles to work in proper sequence) to guide for the correct movement pattern in the joint. Patient education is also key so that a patient can learn what to do at home to reduce pain and how to modify activity until proper mobility and strength is restored. The longer the condition is present, the greater the tendon damage can become and can lead to larger tears and/or a frozen shoulder. If allowed to get to this stage, the condition will take longer to heal with physical therapy and made need orthopedic surgeon involvement with a cortisone injection and sometimes surgery.
Does this condition sound familiar to you? There are solutions that are easy if caught early. Do not let your shoulder problem get to the level where it is limiting your activities. At Optimal Physical Therapy and Sports Performance, a licensed physical therapist can help assess your problem, create an individualized treatment program and assist in your return to your activities. All of our therapists are direct access licensed and are able to evaluate you without the need for a doctor’s prescription. Call us today at 724-779-1300.