Shoulder Impingement

Shoulder impingement can develop for several reasons, and often it is a combination of factors rather than a single cause. One of the most common contributors is repetitive overhead activity. This includes sports like swimming, tennis, or baseball, as well as jobs that involve lifting or reaching above shoulder level. Repeated motion can irritate the tendons and bursa, causing swelling that reduces the available space in the shoulder.

Muscle imbalances or weakness can also play a role. The muscles of the rotator cuff and shoulder blade help keep the joint stable and properly aligned. If these muscles are weak or not working together correctly, the shoulder may move in a way that increases pressure on the soft tissues.

Poor posture is another contributing factor. Rounded shoulders or a forward head position can change the alignment of the shoulder joint, making impingement more likely. This is especially common in people who spend long hours sitting at a desk or using electronic devices.

Age-related changes can also lead to impingement. As people get older, the tendons naturally lose some flexibility and strength. Bone spurs may develop on the acromion, further narrowing the space and increasing the risk of irritation.

In some cases, a previous injury, such as a shoulder dislocation or rotator cuff strain, can alter the mechanics of the joint and lead to impingement over time.

The most noticeable symptom of shoulder impingement is pain. This pain is often felt on the front or side of the shoulder and may worsen when lifting the arm, especially overhead or away from the body. Simple activities like reaching for a shelf, putting on a shirt, or washing your hair can become uncomfortable.

Pain may start as mild and intermittent discomfort that can gradually become more constant if the condition is not addressed. Many people notice that the pain is worse at night, particularly when lying on the affected side.

Another common symptom is weakness in the shoulder. You may feel like your arm lacks strength when lifting objects or performing routine tasks. This weakness is often due to irritation of the rotator cuff tendons.

Limited range of motion is also typical. The shoulder may feel stiff, and certain movements may be difficult or painful to complete. Some people experience a catching or pinching sensation when they move their arm in specific directions.

In more advanced cases, ongoing impingement can lead to rotator cuff tears, which may cause more severe pain and significant loss of function.

Diagnosing shoulder impingement begins with a detailed medical history and physical examination. Your provider will ask about your symptoms, including when the pain started, what activities make it worse, and how it affects your daily life.

During the physical exam, the shoulder will be evaluated for tenderness, strength, and range of motion. Specific movements and tests may be used to reproduce your symptoms and help identify impingement. These tests often involve lifting or rotating the arm in certain ways to see if pain occurs.

Imaging studies may be recommended to confirm the diagnosis or rule out other conditions. X-rays can show the shape of the bones and identify any bone spurs that might be contributing to the problem. While X-rays do not show soft tissues like tendons, they can provide useful information about the structure of the shoulder.

An MRI or ultrasound may be used when more detail is needed. These imaging tools can show inflammation, tendon damage, or tears in the rotator cuff. They are especially helpful when symptoms are severe or not improving with initial treatment.

In some cases, a diagnostic injection may be used. This involves placing a small amount of numbing medication into the shoulder. If the pain improves after the injection, it can help confirm that the source of the problem is related to impingement.

Early diagnosis is important because it allows for more effective treatment and can prevent the condition from worsening. Many cases of shoulder impingement can be managed successfully with non-surgical treatments such as physical therapy, activity modification, and anti-inflammatory measures.