Shoulder Pain? Could It Be Shoulder Impingement Syndrome?
Let me start off by saying: Just because you have shoulder pain, does not mean that something is torn nor do you need surgery! Heck… You may not even have to stop working out, playing golf or tennis, or whatever it is you love to do. One of my favorite quotes from a fellowship instructor is “It’s not WHAT you do, it’s how you do it.” Ever since hearing this, it is how I lead my patient visits.
When a patient enters my clinic with shoulder pain, one of their first questions is – “Is something torn?” Short answer: Maybe. Long Answer: well that’s what we’re about to get in to below.
Shoulder Anatomy: Don’t worry… I will try not to bore you!
Photo Taken From: https://www.semanticscholar.org/paper/PREVENTION-OF-SHOULDER-GIRDLE-INJURIES-IN-CLIMBERS-Dancs%C3%B3/2a76d603fc32cd6ba2df3ea525273ed4c6bfa2c8/figure/3
The “Shoulder” joint is also known as the glenohumeral joint. It is made up of the glenoid fossa (from the scapula or shoulder blade) and the humerus (or arm bone). It is considered a ball and socket joint. This means that one end, the humerus, is shaped like a ball and the other end is shaped like a socket, or in this case, a concave structure. Because of this design, it is has 3 degrees of freedom – meaning it can move a lot and in a lot of different ways. Other joints to consider in this area are the acromioclavicular (AC) joint and the sternoclavicular (SC) joint. AC joint is made up of the acromion (from the scapula or shoulder blade) and the clavicle or collarbone. The SC joint is made up of the sternum (or breastbone) and the clavicle or collarbone.
Photo Taken from: http://www.mytpi.com/articles/fitness/the_role_of_the_shoulder_girdle_in_the_golf_swing
The muscles that help support the shoulder girdle are… the rotator cuff muscles! This includes the supraspinatus, infraspinatus, subscapularis, and teres minor. Some also consider the biceps the 5th rotator cuff muscle which can be debated in any physical therapy Facebook group if you’re interested. These muscles perform arm elevation (reaching overhead), internal rotation (reaching in your pocket or taking your bra off), external rotation (reaching behind you, scratching your head), and abduction (reaching for a cup that is to the side of you).
Something that often gets overshadowed in all this shoulder talk is the shoulder blade or scapula. When raising your arm, the scapula has to move in a 2 degree to 1 degree ratio with the glenohumeral joint. In English, this means that to have full range of motion of your shoulder, your scapula also has to move about half as much as your shoulder. So, if normal shoulder flexion is 160 degrees, your scapula has to move 80 degrees as well. That is a TON of movement which is why I think the shoulder blade is so important when treating shoulders!
There are muscles that aid in helping the shoulder blade achieve this motion and they include the upper trap, lower trap, and serratus anterior.
Photo Taken From: https://www.zachdechant.com/the-other-shrug/
What is Shoulder Impingement Syndrome?
Now that you are an anatomy guru for the shoulder, let’s talk about what happens when things don’t work like they are supposed to in the shoulder.
Ideally, the humeral head rolls in the glenoid without any bumps or potholes (if you’re in Louisiana) along the way. Unfortunately, this is not always the case. With impingement syndrome, the humeral head hits the “roof” of the shoulder joint which then pinches on the muscles of the shoulder joint (usually the rotator cuff) causing pain. Yes, over time, if this is not corrected, you can have a tear of the rotator cuff itself. Again, this does not mean that you need surgery though. The “roof” is made up of the acromion (from the scapula), the coracoid process (also from the scapula), and the coracoacromial arch. All of these can be viewed in the first picture. Because of these different points, patient’s symptoms can vary in location (i.e. front, back, or side of the shoulder), where during the range of motion they occur, intensity of pain, and functional limitations.
Who is at risk for developing shoulder impingement syndrome? New mothers (we just LOVE holding those sweet, squishy faces), string instrument musicians, weightlifters/Crossfitters, heavy laborers, waitresses, jobs that required arm to be in sustained flexion, and sitting with keyboard or arm rests too low.
What are the symptoms of impingement syndrome?
- Difficulty reaching overhead
- Weakness of the shoulder girdle
- Pain with putting on a coat/jacket/shirt
- Pain with reaching behind you (back pocket or bra)
Honestly, if you are experiencing any of these symptoms, please follow-up with a healthcare provider. I would suggest a movement specialist like a physical therapist (or physiotherapist). If you’re an athlete experiencing pain (that includes Weekend Warriors), I would find someone who knows and understands your sport or recreation so that you can get back to doing what you love ASAP! With that being said, below are my THREE go-to exercises for my patients with shoulder impingement syndrome!
Serratus Activation Against Wall with Foam Roller
For this exercise you will need a small resistance band and a foam roller. Begin with a theraband around your wrist and arms shoulder distance apart against a foam roller on the wall (I did not have a foam roller – you can do it without a foam roller, it is just more difficult). Push into the foam roller then slide or roll your arms up the wall keeping tension in the band and a push into the foam roller. Think of bringing your shoulder blades into your armpits. When at the top, hold for 5 seconds. When lowering your arms, lead with your elbows first. Remember to keep looking forward and your chin tucked.
Upper Trap Slides
Facing the wall, standing as close as you can, bring your arms overhead. Reach up to ceiling bringing your shoulders to your ears. Be sure to keep your chin tucked and looking forward. Should look like you’re a referee for football who just called another LSU touchdown! Sorry, couldn’t resist! Hold 5 seconds at the top. If you have pain with overhead movements, start with your arms at shoulder height and bring your shoulders to your ears without moving your arms. You will look more like field goal posts.
Lying on your stomach or over a ball, raise your arms overhead so that they make a "Y." Squeeze your shoulder blades down towards your booty then lift your arms off the table. Keep your stomach tight and try not to over-extend your low back. Hold 5 seconds.
With all of these exercises, perform until fatigue and/or form gets ugly! If you want to see a video of them, head over to my Facebook Page (Neaux Excuses Physical Therapy) or follow me on Instagram (@neauxexcusespt).
Hope this helps with your shoulder woes. If you’re still unsure, contact your local healthcare professional before it gets worse!
Lauren Stone PT, DPT, FAAOMPT, CF-L1