Shoulder Impingement: Symptoms, Causes & Treatment

What is Shoulder Impingement? 

Shoulder impingement syndrome is characterized by the pressure exerted by the acromion bone on the underlying soft tissues of the shoulder joint. This condition occurs when the space between the acromion, muscles, tendons becomes is narrowed due to which the acromion is rubbed against the muscles and other soft tissues. As the rotator cuff is comprised of different muscles and tendons that facilitate shoulder flexion and abduction, the increased pressure in between the acromion bone and soft tissues results in pain and lack of movement at the shoulder [1].

The impingement starts with the pressure exerted by the acromion which produces inflammation in the affected area causing discomfort and pain and ultimately a person is unable to move his shoulder [1].

Symptoms of Shoulder Impingement

The primary symptom of shoulder impingement is a pain in the arm while moving the shoulder upward and while lifting overhead any object. Other associated symptoms include tenderness in the front muscles of the arm, stiffness in the shoulder and arm, shoulder weakness while moving the arm, pain during sleep, and pain while lying on the affected side [2].

Causes of Shoulder Impingement

  • Most of the studies confirm that shoulder impingement is mainly caused by the repetitive and overuse of the shoulders and arms as it may cause the acromion and the tendons to be swelled and as a result, the rotator cuff starts rubbing against each other [3].
  • Moreover, an inflammation in the bursae is another reported cause of shoulder impingement as the fluid-filled in bursae is reduced due to which the friction between the acromion and soft tissues is increased causing pain in the overhead movement [3,4].
  • The structure of the acromion also plays important role in shoulder impingement as a flat acromion deteriorates at a faster rate due to greater friction at the bony structure, causing a shoulder to impinge [4].
  • The bone spur is another cause of shoulder impingement in which an unwanted bony structure is grown in the acromion due to which the pressure is increased at the surrounding soft tissues in the shoulder [4].

Normal Healing Cycle

A normal healing cycle is based on three steps including inflammation, proliferation, and maturation.

  1. The inflammation stage includes increased temperature, redness, swelling, pain, and loss of function. This stage plays a vital role in the healing cycle as the swelling prevents the nearby tissues from further damage, disposal of cell debris and pathogens through increased temperature, and informing the white blood cells to start the healing cycle [5].  
  2. The proliferation stage includes the fibrosis accumulation for scar tissue at the affected area so that the healing process is followed by the fascia restriction, muscle spasm, and trigger points. If the scar tissue is not formed in the proliferation stage, then the healing cycle can never be started.
  3. The final stage of maturation includes the formation of new skin tissues at the affected site representing the completion of the healing cycle [5].

Healing Cycle of Shoulder Impingement

The healing cycle of shoulder impingement is slightly different from a normal healing cycle because it does not include a maturation stage but the cycle repeats itself in between the inflammation and proliferation stages. This is because the scar tissue covers the soft tissues and tries to heal them but repetitive rub between the acromion and soft tissues do not allow the soft tissues to be engaged in fascia restriction and muscle spasm that need to be completed to achieve the trigger points, therefore the healing process remains continuous [6].

Ineffective Treatments for Shoulder Impingement

As shoulder impingement is considered as an umbrella term that covers fibrosis, tendonitis, and other chronic conditions, therefore most of the regular treatment plans are not much effective.

  1. Heat and Ice therapy is usually not effective for shoulder impingement because the heat and ice therapies are intended to relieve muscles and tissues due to fatigue or any other physical reason [6].
  2. Electronic stimulation is also not effective because it stimulates the neural pathways at the shoulder instead of reducing the pressure between the acromion and soft tissues [7].
  3. Foam roller refers to the Self-myofascial Release Technique (SMR) that provides relief from the tightness, inflammation, and soreness in the muscles but this physical relief therapy is not enough for the increased pressure at the shoulder [7].
  4. Massage and stretching are considered to be effective when the muscle and tendons are stressed due to greater muscular activity whereas shoulder impingement includes the increased pressure due to greater resistance in the shoulder [7].
  5. Strength exercise during the inflammation stage is not beneficial because it causes muscle fatigue whereas shoulder impingement can be worsened due to the inflammation, redness, and swelling at the affected site due to increased muscle fatigue [6].

Effective Treatments for Shoulder Impingement

Inflammation stage

During the inflammation stage, having proper rest is the best treatment plan as a lesser movement of the shoulder can reduce the pressure. Moreover, MagnaHeal is more effective to treat shoulder impingement as it consists of a magnet that attracts and aligns the acromion and soft tissues hence, increasing the space between the tissues. Some studies have proved that an anti-inflammatory diet can also be a good treatment approach along with other treatments because an anti-inflammatory diet prevents redness, swelling, and other inflammatory response of the body. Restoring deficiencies is also effective to manage shoulder impingement in the inflammation stage because vitamins, minerals, and salts are vital to complete the healing cycle of inflammation, proliferation, and maturation [8].

Proliferation Stage

During the proliferation stage, the shoulder impingement can be treated through scar tissue release, trigger point release, and fascia release. The scar tissue and trigger point release are done by A3 and A5 which are designed to break the adhesions and positioning of the soft tissues by applying certain ergonomic pressure. This technique helps in re-aligning the soft tissues of the shoulder so that the pressure between acromion is reduced. A3 is used to align superficial tissues, used for scar tissue release, whereas A5 is designed to pressurize the deep tissues, helping in the trigger points release [7,8].

Fascia release is based on the fascia layers composed of superficial and deep (aponeurotic, epimysium, perimysium, and endomysium) layers. For deep muscular fascia layers, A1 and A5 can be used for their release, which is used to soften and re-align the fascia muscular layers so that the shoulder impingement can be relieved or cured [8].

Conclusion 

Shoulder Impingement is chronic and painful disease that can be cured by professional therapists and physiotherapists who can effectively use different therapies (MagnaHeal, A1, A3, and A5) to treat shoulder impingement. 

References

  1. Garving C, Jakob S, Bauer I, Nadjar R, Brunner UH. Impingement syndrome of the shoulder. Deutsches Ärzteblatt International. 2017 Nov;114(45):765.
  2. Ellenbecker TS, Cools A. Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review. British journal of sports medicine. 2010 Apr 1;44(5):319-27.
  3. Cunningham G, Lädermann A. Redefining anterior shoulder impingement: a literature review. International orthopaedics. 2018 Feb;42(2):359-66.
  4. Innocenti T, Ristori D, Miele S, Testa M. The management of shoulder impingement and related disorders: A systematic review on diagnostic accuracy of physical tests and manual therapy efficacy. Journal of bodywork and movement therapies. 2019 Jul 1;23(3):604-18.
  5. Tagg CE, Campbell AS, McNally EG. Shoulder impingement. InSeminars in musculoskeletal radiology 2013 Feb (Vol. 17, No. 01, pp. 003-011). Thieme Medical Publishers.
  6. Marzetti E, Rabini A, Piccinini G, Piazzini DB, Vulpiani MC, Vetrano M, Specchia A, Ferriero G, Bertolini C, Saraceni VM. Neurocognitive therapeutic exercise improves pain and function in patients with shoulder impingement syndrome: a single-blind randomized controlled clinical trial. Eur J Phys Rehabil Med. 2014 Jun 1;50(3):255-64.
  7. Ucurum SG, Kaya DO, Kayali Y, Askin A, Tekindal MA. Comparison of different electrotherapy methods and exercise therapy in shoulder impingement syndrome: A prospective randomized controlled trial. Acta orthopaedica et traumatologica turcica. 2018 Jul 1;52(4):249-55.
  8. Harrison AK, Flatow EL. Subacromial impingement syndrome. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2011 Nov 1;19(11):701-8.