Shoulder impingement is a term that refers to excessive or repetitive contact between the posterior aspect of the humeral head’s greater tuberosity and the acromion process when the arm is in extreme abduction and external rotation ranges. This causes the rotator cuff tendons (superior/inferior supraspinatus/infraspinatus) to get stuck between the acromion process and the tendons.
Causative Factors and Symptoms
A review of the literature reveals several common symptoms shared by the majority of internal impingement patients. Internal impingement patients may exhibit the following symptoms:
- Shoulder Pain in the Posterior Shoulder
- Chronic, diffuse posterior shoulder girdle pain is the most frequently reported symptom in throwing athletes with internal impingement, but pain may also be localized to the joint line. The patient may talk about how the pain started in the back of their shoulder, especially during the late-cocking phase of throwing, when the arm is fully extended (straightened arm) and at 90° of abduction.
- Acute: Acute shoulder pain following an injury is the primary complaint of non-throwing athletes who present with this syndrome.
2. Progressive decrease in throwing velocity-a gradual decrease in throwing velocity or a loss of control and performance in the overhead athlete.
3. Several symptoms of the pathologic process include a so-called “dead arm,” shoulder and arm weakness following a throw, and a subjective sense of the shoulder slipping.
4. Athletes who perform overhead, particularly throwers, frequently exhibit muscular asymmetry between their dominant and non-dominant shoulders.
5. Musculoskeletal/Neuromuscular Imbalance: Muscle imbalances in the shoulder complex, as well as improper neuromuscular control of the scapula, are frequently observed.
6. Increased Laxity: – A patient with isolated internal impingement may experience an increase in global laxity or in the dominant shoulder’s anterior laxity alone.
7. Anterior Instability: – Patients may experience symptoms of anterior instability, such as apprehension or the sensation of subluxation, when their arm is in an abducted and external rotation position.
8. Patients may also exhibit symptoms consistent with other rotator cuff pathologies (tears, other impingements). Patients under the age of 18, particularly throwing athletes, should raise the clinician’s index of suspicion for internal impingement. A lot of different people have said that internal impingement is the most common cause of rotator cuff tears in athletes.
9. A synthesis of internal disarray which popping, clicking, catching, and sliding
10. Rotator cuff weakness – The term “rotator cuff” refers to a group of four distinct muscles (infraspinatus, supraspinatus, teres minor, and subscapularis) and their tendons that provide strength and stability to the shoulder during motion. Separately, the four rotator cuff muscles may contribute to abnormal muscle balance.
11. When your arm moves through the impingement zone, the bursa and rotator cuff come into contact with the outside end of your shoulder blade (acromion). This can happen after a fall, but it’s more common when you move your arm over and over again.
12. The following postures significantly constrict the subacromial space:
- Your arm is directly overhead.
- Your arm is at, near, or above shoulder height.
- An erect posture with rounded shoulders.
Primary and Secondary Causes
Shoulder impingement can happen for a number of reasons, both structural and secondary (posture and movement-related).
Narrowing of the Structure
Structural abnormalities are either present at birth or result from the gradual deterioration of our bone structure as we age. Due to this anatomical restriction, you are more likely to squash, impinge on, and irritate the soft tissues in the subacromial space, resulting in bursitis or shoulder tendonitis. Certain individuals are born with a smaller subacromial space. The growth of subacromial bone spurs, for example, can cut down on the space under the acromion even more.
Instability Under Dynamic Conditions
Impingement can occur if the shoulder is dynamically unstable. If this is the case, a combination of excessive joint movement, ligament laxity, and muscular weakness in the area of the shoulder joint exists. Impingement is most common when people do a lot of overhead work, get hurt, have poor posture, or don’t work out.
When the shoulder is unstable, the rotator cuff is forced to work harder, which can result in injury. An overworked rotator cuff becomes fatigued, inflamed, and weak as a result of pain inhibition or tendon tears. When the rotator cuff isn’t working right, it can’t stop the humerus (upper arm) head from riding up into the subacromial space, which can hurt the bursa or tendons.
Failure to properly treat this instability results in a recurrence of the injury. Overuse injuries, such as bursitis or tendinopathy, are also often caused by bad technique or bad training habits, like overtraining or training too hard.
Shoulder Impingement Classification
Jobe devised a classification system to help differentiate the various degrees of internal impingement. The Jobe classification system is geared toward overhead athletes as the primary patient population.
- Stage I (early): shoulder stiffness and a prolonged warm-up period and discomfort occurs during the late-cocking and early acceleration phases of throwing. There is no pain is reported during daily activities.
- Stage II (intermediate): Pain in the back of the shoulder during the late-cocking and early acceleration stages of throwing is common, but there is absence of pain and instability.
- Stage III: Those who haven’t responded to non-surgical treatments are treated the same as those in stage II.
Doral Health and Wellness improved function for different shoulder conditions and pain. It means that people can work, attend school, or participate in other daily activities without being hindered by their pain. There are a variety of options available to patients and their doctors when it comes to treating pain, some of which are more effective than others. It can be helpful to take a deep breath and let your mind wander. These techniques have the potential to be powerful and successful. Remember that pain can be alleviated, regardless of the treatment regimen. Please peruse this page for information on the most common ailments and their treatments. We’re here to alleviate your pain, so give us a call today.
The pain management procedures at Doral Health are the following:
- Epidural injections
- Facet Blocks
- Intercostal Nerve Blocks
- Intrathecal pump
- Joint Injections
- Percutaneous Discectomy
- Racz Epidural Neurolysis
- Radiofrequency Lesioning
- Selective Nerve Root Blocks
- Spinal Cord Stimulation