- Are you suffering pain around the shoulder joint and down the outside of the upper arm?
- Are you experiencing pain with overhead activities such as putting out the washing, swimming or tennis?
- Is your shoulder pain stopping you from lying on your side at night?
You could have shoulder impingement! Shoulder impingement pain can radiate from the shoulder to the outside of the upper arm. It can be caused by pinching of the tendons and/or bursae inside the shoulder joint.
What is Impingement?
Let’s start by understanding some of the shoulder anatomy. A bursae is simply a small sack of fluid that protects bony prominences. We have them all over our body, such as the tips of our elbows, the outer hip area, the heels. There is a small bursa that sits just under the end of your collarbone.
The scapular (shoulder blade) drapes over the rib cage like a cape and connects to the collarbone to form the roof of the shoulder joint. The arm bone (humerus) connects with the socket (on the scapula) to create the ball and socket part of the shoulder joint.
The socket is very shallow, like a golf ball to a tee, so we rely on four small tendons to hold the ball stable in the socket and prevent excessive slip and slide. These four tendons are collectively called your rotator cuff tendons.
If the shoulder blade and collar bone complex is not positioned well on the rib cage, or if the ball is not held stable and centred in the socket, this can reduce the space in the top of shoulder and contribute to pinching of the underlying tendons or bursae. Watch this short video here to understand how the shoulder blade position can contribute to your pain.
How do the rotator cuff tendons contribute?
A tendon is like a thick piece of rope that attaches a muscle to a bone. Your four small rotator cuff tendons are designed to hold the ball stable in the shallow socket. If there is weakness or imbalance in the function of these muscles and tendons it can contribute to excessive slide in the joint and inevitable compression of the top tendon underneath the roof of the socket. This is typically felt as pain down the outside of the arm with certain shoulder movements. If this tendon becomes weak or starts to fray from repetitive compression, we can have pain and symptoms around the joint and down the arm, commonly known as tendinopathy and bursitis caused by shoulder impingement
How can we treat this?
Firstly an assessment is essential to determine why the problem has occurred. Common reasons can include:
- Non optimal positioning of the rib cage under the scapular, which can affect the overall position and function of the scapula.
- Reduced muscle control around the scapula. Your shoulder blade functions like the base of a crane for your arm. If the base of the crane starts to tip, it makes it very difficult to lift the arm or perform repetitive overhead activities without compromising the joint.
- Reduced strength and control in the rotator cuff tendons resulting in excessive slide of the ball within the socket
- Repetitive overhead loading
- The natural shape of your shoulder joint can decrease the space of the shoulder joint
Tips to help:
- Activities that irritate the tendons or bursae should be avoided until your shoulder control has improved. These activities are usually repetitive overhead activities, putting the hand behind the back, sleeping on the sore shoulder and high load activities such as lifting heavy and awkward items.
- Ice or anti-inflammatory gel can help reduce swelling in the bursa
- Sleeping is best performed on the non-painful side with a pillow between the arms and the neck in a neutral position.
- Your home exercise program outlined by your physio is an important component of addressing the underlying cause of your problem. Exercises often include strengthening of the shoulder blade and small rotator cuff tendons. Watch this short video here for an example on how to start strengthening your shoulder blade control!
- Quick movements (such as throwing or catching) can be painful and should be avoided until your shoulder is stronger.
- Releasing the muscles around the shoulder (over the back of the shoulder and the shoulder blade) with a trigger tool such as a spikey ball can be helpful-your physiotherapist will outline this if it is suitable for you.
We look forward to helping you understand your pain and what to do about it! Recover from your pain and get back to doing the things you love. Like to book and appointment? Simply book online, or contact us on 07 5448 3369