Are you the type of athlete who plays through the pain? While that can seem relatively harmless if you have minor muscle soreness, many conditions can actually become worse without rest and proper treatment.

Shoulder impingement syndrome can start out as nothing more than mild pain. But left untreated, impingement syndrome can become serious and painful. Let’s take an in-depth look at what shoulder impingement syndrome is and how it can be treated.

What is Shoulder Impingement Syndrome?

As the name implies, this syndrome impairs your ability to move your shoulder. The condition is also referred to as “swimmer’s shoulder” and “thrower’s shoulder.” Shoulder Impingement Syndrome may develop quickly following the partial tear of a rotator cuff tendon but may also develop slowly over time.

Basically, shoulder impingement syndrome occurs when the tendons of the rotator cuff become squeezed or blocked where they pass through the shoulder joint. This narrow space is the subacromial space. If the tendons which pass through this space are repeatedly pinched and irritated, pain and mobility impairment can result.

Your rotator cuff is a collection of tendons and muscles in your shoulder. They work together to move your arm in a variety of ways. Most injuries to the rotator cuff involve upward, rotating and overhead movement.  

Note that impingement syndrome is a symptom, not a diagnosis. From a strictly medical standpoint, a person doesn’t have “impingement syndrome.” Rather, the syndrome is a sign which points to one of these potential medical issues:

  • Bone Spurs
  • Biceps Tendinopathy
  • Labral Injury
  • Rotator Cuff Injury
  • Shoulder Instability
  • Scapula Dysfunction

Left untreated, a shoulder impingement can turn into a rotator cuff tear. Unfortunately, tears can require lengthy rehabilitation and possibly even surgery. Identifying the cause of an impingement can help prevent a major shoulder problem from developing.

How Do I Know if I Have Shoulder Impingement?

Diagnosing a shoulder impingement can be tricky. Because there are so many potential causes, symptoms can vary fairly substantially. Basically, you want to pay attention to any consistent and worsening shoulder pain.

In most cases, the shoulder injury will develop gradually. Impingement pain is typically localized in both the front and the back of the shoulder joint. You’ll likely feel the most pain during overhead movements such as throwing, reaching or swimming.

You can’t really diagnose shoulder impingement on your own. If you have persistent shoulder pain, you’ll want to schedule an appointment with a doctor or sports injury professional. Early diagnosis often results in quicker and more effective treatment.

Diagnosis of Impingement Syndrome   

Your doctor or therapist will ask you some questions about your shoulder pain. Did the pain occur after an impact or did it develop over time? Do you have any history of shoulder pain or injury? Your age will also be considered. Shoulder injuries such as rotator cuff tears are far more common among people over the age of 40.

After asking questions about your medical history, your shoulder will then be examined. The doctor will look for swelling, bruising and other signs of trauma. If you notice any of these signs yourself, that’s a clear sign you need to schedule an appointment.

No two people are the same. So your doctor will often compare your injured shoulder to your other one. This helps determine if the injured shoulder is swollen, incorrectly positioned or otherwise has an altered function.

Next, the doctor will examine your shoulder for any tender spots. Light pokes help the doctor determine where the pain is the most severe. Sore spots help identify the specific muscles and tendons which may be injured.

The doctor will also probe for muscle tightness. Changes in the look and warmness of your skin are another helpful diagnostic tool. If blood flow is impaired, your skin will feel cool and look pale.

Finally, your doctor will look at the range of motion for the shoulder. There are two different types of shoulder motions. Active moves are ones you can perform yourself, such as raising and rotating your arm. Passive actions are ones where you relax your arm so the doctor or therapists can move it into various positions.

Resistance tests are another way to gauge motion range and strength. In most cases, you’ll simply press your fist against the doctor’s palm. Your shoulder strength will be compared to the power of your uninjured arm.

Shoulder Impingement Tests

Once general shoulder impairment is determined, your doctor will likely perform a few more specific tests. These tests help determine any damage to the Supraspinatus tendon, which is a thick tendon connecting a major muscle to the shoulder joint. Ideally, the specifics of your shoulder pain can be diagnosed with one of these simple, non-invasive methods.

The Empty Can Test

For the Empty Can Test, you’ll hold your arm out at a 45-degree angle. Your thumb will be positioned towards the floor, which looks like you’re holding an empty can.

The doctor will provide resistance to the top of your arm. Your strength level, especially as compared to your other arm, will help determine the extent of any damage to the Supraspinatus tendon.

Neer’s Sign

Your arm will be placed at a 45-degree angle to your body with your thumb down. This is a similar starting point to the Empty Can test. Only instead of pushing against resistance, you’ll lift your arm up over your head – or at least as far as possible based on your pain levels. The range of mobility helps your doctor determine the extent of the potential tendon damage.   

Hawkins-Kennedy Test

This test has a different starting position. Your arm is raised in front of you with your elbow bent at a 90-degree angle. The doctor will then rotate your arm by turning your wrist down and elbow up.

Treatment for Shoulder Impingement

Fortunately, most treatments require no invasive surgery. As long as you follow the doctor’s instructions carefully, you’re unlikely to suffer any long-term damage. Treatment processes have two goals: reduce pain while increasing function.

The standard treatment used to treat impingements is the PRICE principle. This is a five-point plan which involves:

  • Protection
  • Rest
  • Ice
  • Compression
  • Elevation

First, protect the shoulder from additional injury. Unfortunately, this doesn’t mean you can just “take it easy” on the baseball field or in the pool. You need to stop all activities which involve overhead arm motions such as throwing or swimming.

In other cases, you might have to take some time off from work, especially if your work involves manual labor. While taking unwanted time off isn’t ideal, continuing to put strain on an existing shoulder injury can result in more pain and less mobility for a longer period of time. Rest is vital to proper rehabilitation.

Ice is a simple, effective solution you can use at home. Apply an ice pack or cold compress to the shoulder. Keep the cold against the sore area for 10 to 15 minutes every hour. Do this about three or four times a day. Be careful not to put ice directly on your skin because that can result in an ice burn.

Along with ice, you can also use over-the-counter anti-inflammatories such as ibuprofen. This will help reduce inflammation and pain. In cases of severe injury, your doctor may prescribe a stronger prescription anti-inflammatory.

Final Thoughts

Your shoulder is an intricate machine powered by tendons, bones and muscles. When those connections break down, you’ll likely experience pain and loss of mobility. Never try to simply tough out your shoulder pain. That will likely result in further damage.

At the first sign of shoulder impingement, protect and rest your shoulder. Avoid overhead, circular motions. Ice your shoulder regularly. Perhaps most importantly, schedule an appointment with a doctor or physical therapist as soon as possible. Only a qualified professional can provide an accurate diagnosis and help develop an appropriate treatment plan.

Shoulder impingement syndrome has many potential causes. But all signs of shoulder pain, even mild ones, need to be taken seriously. Fortunately, with rest and treatment, you’ll be back in the game in no time.

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