Injury

My right shoulder has been aching for months, mainly during bench and shoulder pressing. I’ve worked through minor aches and pains before, but this one is getting worse. Therefore, I’ve decided to take a little break from such exercises to allow my shoulder to heal. In fact, while studying for my ACE certification I think I stumbled on exactly what the problem is: impingement syndrome.

What is it?
Impingement syndrome is a condition that affects the rotator cuff, causing shoulder pain. The rotator cuff is a group of muscles and tendons that secures the arm to the shoulder joint and allows the arm to rotate.

Who gets it?
Impingement syndrome is more likely to occur in people who engage in physical activities that require repeated overhead arm movements, such as tennis, golf, swimming, weight lifting, or pitching a ball, or whose profession requires repeated overhead lifting. Impingement syndrome can also occur in people with rheumatoid arthritis.

What causes it?
Repeated movement of the arm overhead can cause the rotator cuff to contact the outer end of the shoulder blade where the collarbone is attached, called the acromion. When this happens, the rotator cuff becomes inflamed and swollen, a condition called tendonitis. The swollen rotator cuff can get trapped and pinched under the acromion. All these conditions can inflame the bursa in the shoulder area. A bursa is a fluid-filled sac that provides a cushion between a bone and tissues such as skin, ligaments, tendons, and muscles. An inflammation of the bursa is called bursitis.

What are the symptoms?
Impingement syndrome results in shoulder pain that can extend from the top of the shoulder to the elbow. (I only have it in the shoulder, and only feel pain when lifting significant weight.) In the beginning, the pain occurs whenever the arm is raised over the head. (Just raised my arm; no pain.) While the pain may not occur when the arm is at rest, it may flare up when sleeping because of pressure on the shoulder area. With time and repeated motion, the arm becomes weak, with little range of motion. Eventually, tiny tears in the fibers of the rotator cuff can progress to a larger tear in the tendon or even pull the tendon off the bone. Impingement syndrome is usually accompanied by shoulder tendonitis and bursitis.

How is it diagnosed?
To diagnose impingement syndrome, your doctor will ask about your physical activities and will examine both shoulders. He or she will check for tenderness in the shoulder and will test your range of motion by having you move your arm to a variety of positions. He or she will also perform strength tests, such as pressing down on your arm as you try to keep it in a raised position with the elbow bent. Diagnostic tests may include x-rays to check the condition of the bones in the shoulder area, or magnetic resonance imaging or ultrasound scans to look for tears in the rotator cuff. Shoulder pain can sometimes be caused by a problem with the cervical spine, which is in the neck area. Your doctor will check this area to rule out this cause. If your doctor suspects impingement syndrome, he or she may inject a small amount of pain relieving medication, such as lidocaine hydrochloride, into the space under the acromion. Pain relief from this injection usually indicates impingement syndrome.

What is the treatment?
Treatment for impingement syndrome begins with rest, ice packs, and anti-inflammatory medications. Massage of the injured shoulder by a nurse-in-training with a gentle touch is also recommended, if possible. Ultrasound therapy may also be recommended to stimulate the tissues and improve blood flow. After the pain is gone, you will be able to begin stretching and strengthening exercises, as recommended by your doctor. Most patients see an improvement within 6 to 12 weeks. Some patients also benefit from a limited number of corticosteroid injections into the space under the acromion to reduce inflammation. If this treatment is not successful within 6 to 12 months, your doctor may recommend surgery to release the ligament, followed by physical therapy to gradually increase your range of motion. You may need to modify your physical activities to reduce the possibility of a relapse.

Self-care tips
You can prevent impingement syndrome by avoiding the type of repetitive motions that irritate the rotator cuff. If you do engage in physical activities that require these types of motions, follow a regular program of strengthening exercises, using light weights, to keep the rotator cuff muscles strong.