Impingement Syndrome

What Is Impingement Syndrome?

Impingement syndrome is a condition that occurs when the structures (muscles, tendons, bursae) that run through the subacromial space (space beneath the acromion, directly above the shoulder joint) in the shoulder become impinged or squeezed. This may occur due to factors including poor shoulder positioning/alignment, impaired shoulder stability, and altered biomechanics and movement. Impingement can lead to inflammation, tendonitis, swelling, tears, etc.


What Are The Causes Of Subacromial Impingement Syndrome?

Impingement can be caused by a patient’s specific anatomy, including the shape of their acromion or presence of osteophytes/bone spurs which may narrow the subacromial space. Impingement may also be caused by biomechanical issues, including poor posture, forward positioned humeral head, shoulder instability, tight muscles, impaired joint mobility, poor flexibility, muscular weakness, etc.


What Are The Signs And Symptoms Of Shoulder Impingement?

Signs and symptoms include a painful arc of motion with lifting the arm (usually from 60 degrees to 120 degrees), rotator cuff weakness, forward humeral head within the joint, muscle tightness, and positive results on physical therapy special tests.


What Are The Risk Factors Of Subacromial Impingement Syndrome?

Individuals with poor posture, impaired biomechanics and rotator cuff weakness are likely to develop impingement syndrome. Patients with a history of rotator cuff degeneration/tears may also be at higher risk. Individuals over 40 are also more likely to develop this condition.


How Is Impingement Syndrome Diagnosed?

It may be diagnosed by a physical therapist when the patient exhibits signs and symptoms consistent with impingement and positive results on physical therapy movement based on special testing. MRI and X-ray imaging may be helpful but are not necessary to diagnose the condition.


What Are The Possible Treatments For Impingement Syndrome?

Physical therapy to treat impingement syndrome begins with hands-on manual therapy, including soft tissue and myofascial mobilization, as well as joint mobilization. These techniques aim to improve the muscle’s flexibility, length, texture, and tenderness and improve the alignment and mobility of the shoulder joint. The physical therapist may also do manual work on the patient’s neck or upper back to make sure the body is working cohesively and the shoulder is not compensating for another issue in nearby regions.  PT will also include strengthening and stabilization of shoulder musculature, including the rotator cuff and other postural muscles. Neuromuscular re-education will be taught and the patient will learn how to stabilize the shoulder blade and separated shoulder movement from arm movement so that the subacromial space is preserved during overhead motion. On a case by case basis, the PT may also discuss with the patient and their medical team if injections may be beneficial.


Are There Preventative Steps Or Measures To Avoid Subacromial Impingement Syndrome?

Maintaining proper posture throughout the day and possessing good flexibility and strength of the shoulder rotator cuff and other stabilizing muscles.


What Are The Risks If A Shoulder Impingement Is Left Untreated?

If left untreated, impingement may lead to chronic shoulder pain, tendinosis, osteoarthritis, bone spurs, or rotator cuff tearing.


Are There Other Related Conditions To Impingement Syndrome?

Shoulder tendonitis, OA, rotator cuff tears


Key Takeaways About Impingement Syndrome

Spring Forward PT’s approach to shoulder impingement highlights manual therapy. Making sure the shoulder’s connective tissue, muscles, and joints are moving properly is essential to correcting impingement, especially before beginning a program of strengthening and stabilization.
The rotator cuff consists of 4 muscles that must work cohesively to perform shoulder motion and humeral head stabilization. When one of the muscles is stronger than the others, imbalances occur that contribute to impaired mechanics.
When rehabbing the shoulder, Spring Forward PT considers the patient’s individual injury presentation. We work with you to achieve a greater level of wellness, whether your goals are to reach into a high cabinet, do a handstand, or rock climb.


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