Do you get a sharp, debilitating pain in your shoulder when you are performing tasks like brushing your hair, putting on certain clothes or showering?

During these movements, where you raise your arm out to the side and then upwards over your head, do you alternate between no pain and pain? For example, during the first part of the moment you don’t feel any pain, and then suddenly your shoulder “catches” and there is sharp pain, followed by no pain again as you continue to move your arm upwards.

These are all signs of a condition called Shoulder Impingement Syndrome (SIS), where the tendons of the rotator cuff muscles at stabilise your shoulder get trapped as they pass through the shoulder joint in a narrow bony space called the sub-acromial space.

Impingement means to impact or encroach on bone, and repeated pinching and irritation of these tendons and the bursa (the adding under the shoulder bone) can lead to injury and pain.

Shoulder complaints are the third most common musculoskeletal problem after back and neck disorders. The highest incidence is in women and people aged 45–64 years. Of all shoulder disorders, shoulder impingement syndrome (SIS) accounts for 36%, making it the most common shoulder injury.

You shouldn’t experience impingement with normal shoulder function. When it does happen, the rotator cuff tendon becomes nflamed and swollen, a condition called rotator cuff tendonitis. Likewise, if the bursa becomes inflamed, you could develop shoulder bursitis. You can experience these conditions either on their own, or at the same time.

The injury can vary from mild tendon inflammation (tendonitis), bursitis (inflamed bursa), calcific tendonitis (bone forming within the tendon) through to partial and full thickness tendon tears, which may require surgery. Over time the tendons can thicken due to repeated irritation, perpetuating the problem as the thicker tendons battle to glide through the narrow bony subacromial space. The tendons can even degenerate and change in microscopic structure, with decreased circulation within the tendon resulting in a chronic tendonosis.

WHAT DOES THE TREATMENT INVOLVE?

There are many structures that can be injured in shoulder impingement syndrome. How the impingement occurred is the most important question to answer. This is especially important if the onset was gradual, since your static and dynamic posture, muscle strength, and flexibility all have important roles to play. Your rotator cuff is an important group of muscles that control and stabilise the shoulder joint. It is essential the muscles around the thoracic spine and shoulder blade are also assessed and reated as these too work together with the entire shoulder girdle.

To effectively rehabilitate this injury and prevent recurrence, you need to work through specific stages with your therapist.

These stages may include:

  • Early Injury: Protection, Pain Relief, & Anti-inflammatory Treatment
  • Regain Full Shoulder Range of Motion
  • Restore Scapular Control and Scapulohumeral Rhythm
  • Restore Normal Neck-Scapulo-ThoracicShoulder Function, including posture correction
  • Restore Rotator Cuff Strength
  • Restore High Speed, Power,
  • Proprioception and Agility Exercises
  • Return to Sport or Work

The early stages of treatment will involve manual therapy, including massage to relieve pain and release tight structures as well as mobilisation techniques to restore normal shoulder movement. Strapping/taping has been shown to be helpful in reducing pain as well as ultrasound and laser therapy. As you move through the other stages of treatment your therapist will prescribe rehabilitation exercises specific to your shoulder, posture, sport and/or work demands.

Corticosteroid injections can be useful in the initial pain relieving stage if conservative (non-surgical) methods fail to reduce the pain and inflammation. It is important to note that once your pain settles, it is important to assess your strength, flexibility, neck and thoracic spine involvement to ensure that your shoulder impingement does not return once your injection has worn off.

Some shoulder impingements will respond positively and quickly to treatment; however many others can be incredibly stubborn and frustrating, taking between 3-6 months to resolve. There is no specific time frame for when to progress from each stage to the next. It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and frustration.