Shoulder pain is a very common complaint that we see in the clinic during the spring months. As we venture outside during the warmer spring days, we begin to use our bodies again in ways we haven’t had to since putting that lawn mower away last fall. Typically, in the early spring, landscaping duties such as mulching, mowing, pruning and trimming bushes call on us to use our shoulders in a more vigorous way that normal. Activities such as pull starting a lawn mower, using a pitchfork to mulch or pole pruner in trees are all strenuous activities for our shoulders and can lead to overuse injuries such as shoulder tendinitis or bursitis. Collectively this syndrome is known as shoulder impingement and can lead to pain at night in the affected shoulder and prevent a good night’s sleep.
What is Shoulder Impingement Syndrome?
Shoulder impingement syndrome affects the tendons and bursa associated with the rotator cuff. The rotator cuff is the group of muscles that raise and rotate the arm at the shoulder. Rotator cuff problems range from tendonitis and bursitis to partial and full thickness rotator cuff tears. Rotator cuff pain is often located on the upper-outer arm and is aggravated by overhead activities. Rotator cuff pain may be worse at night. Inflammation of the rotator cuff (tendonitis) and its bursa (bursitis) are referred to as “impingement syndrome”. Impingement syndrome results from a pinching of the rotator cuff tendons and bursa between the top of the humerus (arm bone) and the acromion (tip of the shoulder bone). This leads to thickening of the tendons, pain and poor function of the rotator cuff. With the thickening of the tendons in an already tight space, continued use of the arm can lead to a vicious cycle of progressive pain, poor cuff function and more thickening. Treatment is directed at decreasing the inflammation and improving the rotator cuff function, which serves to pull the humerus down and away from the acromion relieving the impingement. Rarely is surgery necessary to treat impingement syndrome, if detected early enough.
Treatment Options for Shoulder Impingement
Physical therapy can expedite the resolution of symptoms significantly. In general, treatment involves oral anti-inflammatories and “pain free” exercises including rotator cuff and scapular stabilizer strengthening in a “sub-impingement” range of motion and gentle stretching. Sometimes an injection of cortisone into the shoulder can be very effective in reducing inflammation and allowing the restoration of pain free range of motion.
Because there are many causes of shoulder pain, it is important to seek a diagnosis by an experienced clinician so that appropriate treatment can be initiated. Most shoulder pain can be effectively alleviated in a relatively short period of time to allow quick return to activities.
Marc Forrest, PT, MSPT, OCS (Board Certified Orthopedic Specialist), practices physical therapy with Hampton Roads Orthopedics and Sports Medicine. Marc and his team treat a range of patients for orthopedic and sports medicine needs at their Newport News Location, 730 Thimble Shoals Boulevard, in Oyster Point.