A very common cause on wide spread shoulder pain is an impingement syndrome. This type of injury can be due to the rotator cuff muscles in the back of the shoulder or the structures around the front of the shoulder and occurs when the space, in which the tendons run through, decreases. Shoulder impingements can occur for a number of reasons, including:
- An overuse through repetitive movements
- A muscular tear
- A postural imbalance
- A heavy impact where the shoulder is forced into a weakened position under load, for example rugby tackle
- Calcium deposits in the tendons
Three symptoms associated with a shoulder impingement are:
- Non-descriptive pain around the shoulder
- A reduction in active range of movement
- Tender to touch
The pain stems from the decreased space for the muscle insertion points along with the inability to move the shoulder blade in a smooth fashion. The decreased pain free range of movement will be the result of any inflammation around the joint or any calcium deposits in the tendons. If there is inflammation present in a shoulder impingement the pain will become more wide spread and start affecting the muscles at the front of the joint as well.
How to differentiate between a shoulder impingement and other shoulder injuries…
There are a few very simple tests and movement patterns that can begin to identify a shoulder impingement:
Firstly, shoulder flexion in internal rotation. To do this bring both arms out in front of you, turn the thumb towards the floor with the palms now facing outwards take the straight arms from beside your hips to above your head in one slow and fluid motion. If you experience pain on this movement it is likely rotator cuff muscles are holding tension. To confirm this finding perform an external rotation by placing a towel between the arm and body to keep the elbow by your side throughout this movement, bend the elbow to 90° and take the forearm from a position directly in front of you moving the hand out to the side.
Secondly shoulder abduction, take straight arms with palms facing the body from beside you moving up to the outside all the way above the head. With a shoulder impingement there is likely to be a block of pain from roughly 90° to the top of the movement, this is known as the ‘painful arc’ and suggests there is a significant reduction in space for the tendons to move and therefore resulting in a non-fluid movement pattern of the scapular.
Finally, a test to differentiate between the rotator cuff muscles and the front of the shoulder is the ‘empty can test’, simply raise a straight arm to 45° in front of you, turn the thumb towards the floor and take the arm outwards slightly. Keep the arm straight and press directly upwards against a resistance; you are looking for pain and/or weakness in comparison to the uninjured side.
This is certainly not an exhaustive list of tests and movement patterns to diagnose a rotator cuff impingement but it is a comprehensive start. To get a full understanding of the extent of the injury, a full examination is recommended.
Six conservative ways to treat a shoulder impingement include:
- Ice, reduce any inflammation around the joint
- Keep moving it, inactivity will cause the muscles to weaken, which will worsen the problem, and your shoulder will stiffen up
- Massage is a great way to loosen off the specific muscles that are causing the symptoms
- Corrective exercises, these involve rotator cuff strengthening, scapular setting, thoracic spine mobility and postural education.
- Steroid injections
A combination of all of the above is the most productive way to conservatively overcome a shoulder impingement.
If you suffer with any of the symptoms mentioned or have any questions and are interested to find out more, come and see me!
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