Shoulder Impingement Syndrome and Treatment

Shoulder pain develops for a variety of reasons, and there are many treatment and rehabilitation options available.

What is Shoulder Impingement Syndrome?

The rotator cuff and shoulder area can develop instability, and it can suffer many types of injuries and stressors, from arthritis to tendinitis (tendonitis), from calcifications to adhesions, and from bursitis to shoulder impingement syndrome. Shoulder impingement syndrome is sometimes called thrower’s shoulder or swimmer’s shoulder. The rotator cuff muscles have tendons, and if they become inflamed and irritated, loss of movement, weakness, and pain can result. Overhead movement worsens the pain, and the patient may have more discomfort at night, especially if the patient lies on the injured shoulder. An acute injury can trigger this problem, or the problem may have a gradual onset, such as if an osteoarthritic spur is involved. The shoulder may grind or pop when moved, and the range of motion might be limited.¹ The lubricating sac (bursa), between the bone on top of the shoulder (acromion) and the rotator cuff, helps the tendons of the rotator cuff to “glide freely”. Impingement means that the acromion is rubbing against the bursa and tendon, and that is the cause of the pain and irritation.² Therefore, shoulder impingement syndrome involves the tendons, but it also affects the bursa. Bone and joint abnormalities can be part of the cause, but swimming, tennis, lifting, painting, and other repetitive overhead activities can also bring on this condition. Left untreated, shoulder impingement syndrome could lead to bursitis, tendinitis, a rotator cuff tear, or even biceps muscle rupture.³ Rotator cuff pain may radiate down the arm, and there may be sudden pain with reaching or lifting movements. Patients may also have loss of strength and trouble performing activities that involves putting the arm behind the back. The shoulder may also feel tender.⁴

Treatment Options

There are many types of exercises that patients can follow to stretch and rehabilitate the shoulder, including instructional online videos.⁵ Standard treatments for shoulder pain include rest, NSAID medications, physical therapy, and steroid injections. There are also surgical treatment options, such as arthroscopic and open surgical techniques. Rehabilitation would be required after any surgery, and it can take months to a year to relieve pain.⁶ There are side effects with anti-inflammatory medications, such as upset stomach, vomiting, ulcers, and constipation. Cortisone shots, which cause side effects less often than oral medications, still have a risk of weight gain, elevating blood sugar, compromising the immune system, raising blood pressure, thinning skin, and osteoporosis.⁷ Chiropractors are experts in musculoskeletal issues, and they can treat rotator cuff injuries. Chiropractic treatment typically includes “ultrasound, spinal manipulation, soft tissue therapy and a variety of home exercises”.⁸ Other treatment modalities include electro-stimulation therapy and cross-friction massage, to relax the muscles and improve mobility.⁹ Active Release Techniques, or ART, is another useful treatment option some chiropractors can offer patients.^{10, 11}