Shoulder pain is a common complaint shared by people of all ages and activity levels. By far the most common diagnosis, shoulder impingement syndrome accounts for 44-65% of all shoulder complaints.
When the arm is raised to shoulder height and above, the space between the roof of the shoulder (acromion) and the upper arm bone (humeral head) narrows. This space contains the muscles of the shoulder (rotator cuff) and a sac of lubricating fluid (bursa). Shoulder impingement occurs when the rotator cuff and bursa get pinched between the two bones as the arm is raised, leading to irritation and pain.
Symptoms of Shoulder Impingement
Patients will commonly locate their pain around the shoulder and outer portion of the upper arm. Their pain will worsen with shoulder functions, especially when reaching overhead or lifting. The patient will describe difficulties with certain movements, especially when reaching behind their back to tuck in a shirt, reach a back pocket or unsnap a bra. Often, this pain will wake patients up at night or prevent them from sleeping at all.
Physical Therapy As Effective As Acromioplasty
The evaluation of shoulder pain usually involves X-rays to evaluate the bony structures of the shoulder. Often times, patients will have small bone spurs along the front of the acromion. These spurs were once thought to be the main cause of shoulder impingement syndrome, with treatment requiring surgery to remove these spurs, referred to as an acromioplasty. However, scientific research has clearly shown that treatment of these spurs is unnecessary. Both physical therapy or a supervised home exercise program were found to be as effective as surgery, and without the associated risks and complications.
Most patients with shoulder impingement syndrome demonstrate different combinations of inflammation, stiffness and weakness. Their shoulders are moving abnormally, and it is this abnormal motion that leads to pain and irritation. Thus, it is important that a thorough examination of the shoulder be performed to effectively treat all of these different elements.
The two goals of treatment for shoulder impingement syndrome are to alleviate pain and inflammation, and to get the shoulder moving normally again. Pain and inflammation are treated through different combinations of ice, anti-inflammatories and cortisone injections. Stiffness and weakness are treated with either home exercises or formal physical therapy and are based on a careful examination of the patient's shoulder. This treatment regimen has been highly effective, leading to resolution of most patient's pain in about six weeks. Very rarely is surgery recommended, and in those cases patients' usually have other conditions in the shoulder, such as arthritis or a rotator cuff tear.