Shoulder Impingement and Shoulder Bursitis
Shoulder Impingement is shoulder pain that involves compression (impingement) of the bursa (a lubricating sac) and/or rotator cuff tendons by the shoulder blade. Either the bursa can become irritated which is known as bursitis, and/or the rotator cuff tendons can become irritated or have degeneration known as tendonosis. If left untreated, degenerative tearing of the rotator cuff may occur.
Shoulder impingement is very common- particularly in people who perform repetitive motion at or above shoulder level. Other activities that predispose a person to shoulder impingement include: swimming, throwing, playing tennis, lifting weights, playing golf, playing volley, gymnastics, painting, stocking shelves.
Shoulder impingement symptoms are not specific to any specific rotator cuff muscle and can be diagnosed with a variety of testing. The following is a list of the stages of shoulder impingement which follow a dysfunctional movement pattern:
- Stage 1: Inflammation and swelling, usually in patients under the age of 25.
- Stage 2: Weakening of the tendons (connection between muscle and bone) in the shoulder known as tendinopathy, usually in patients between the ages 25-40.
- Stage 3: Rotator cuff tear, biceps tendon tear/rupture, bony abnormalities, patient is usually over the age of 40.
What causes this compression at the shoulder? It could be and usually is a combination of things. When people have or develop an extra-mobile shoulder the arm can move more in the joint causing more friction and rubbing. Other times, the shoulder becomes very restricted which results in a loss of the normal range of motion. This may be from poor posture (think seated slumped at your desk and computer or while you’re texting in class maybe?) or possibly you changed the way you hold your arm to your body following a tweak or injury of some sort. This decreased mobility may cause more compression, rubbing, and irritation as well. And finally, there could be bony changes known as bone spurs that stick out into the joint spaces.
Most of the time, pain at the shoulder occurs when the person lifts the arm overhead or is reaching backwards. The pain is located normally at the top or front of the shoulder and can also be down the side of the arm. A common complaint is pain at night when the person lies on the compromised shoulder that experiences pain.
What can a physical therapy and chiropractic team do for you?
We would address the inflammation in the shoulder as you would expect through varies treatment options but then we would look to understand the movment patterns of the entire body. We would first need to determine what dysfuntional movement patterns you have. Once we’ve identified your movement dysfunction then we need to determine why you have movment dysfunction. Do you have joints or muscles/soft tissues that aren’t moving well? Once we clear your joint and soft tissue/muscle’s ability to move, we also need
to find out if you have the ability to properly coordinate your movement patterns which we often refer to as motor control. Once we’ve determined which of these problems you have (you might have both) then we can properly help you rehabilitate your shoulder symptoms. We might be working on stretching the muscles that could be pulling your shoulder forward causing the impingement and compression. We might also work on strengthening the muscles that stabilize the shoulder blade and shoulder joint while being careful to give the irritated/inflamed muscles the appropriate rest for healing. But most importantly, as a team we would address and rehabilitate dyfunctional movement patterns wherever they are in your body because they are often playing big roles in you shoulder pain syndrome as well.
One area of focus is often your thoracic spine: this is your spine from your neck to your low back. When you sit in a slumped, rounded state the spine begins to change from it's natural state into an overly rounded posture. From there, the ribs attach to the spine and the shoulder blade sits on the ribs. If the spine rounds forward, the shoulder blade follows suit. The result is that with reaching and overhead motions, impingement occurs and therefore pain is experienced. If you look at the picture to the right, the shoulder blade has rotated forward resulting in less freedom at the ball of the shoulder. On the left, the back is able to extend and the shoulder blade is shifted backwards allowing more range. At Arvada Sport and Spine Group our chiropractors and physical therapists will often work as a team to address this lack of mobility by addressing your specific need whether it be a joint or tissue problem, or movement coordination problem (motor control).
It is also possible that your mid back could also be very flat, which doesn’t allow the shoulder blade a smooth surface to glide and rotate on. If this is the case then a different rehabilitation plan will also be used. We may even need to focus on appropriate breathing techniques. See a previous blog on this topic. ( Breathe Like A Baby. Again.)
In the end there are many reasons why this type of shoulder pain can exist. Only a complete evaluation to determine the true functional cause of your pain syndrome can give you answers with regard to the proper rehabilitation. What may help your neighbor might actually make your condition worse. If you are having shoulder pain whether it is an impingement syndrome or not our team of sports chiropractors, and physical therapists are here to help you find your answers.
Picture 2 from dynamicchiropractic.com.
Dixon JB, Kruse D, Simons SM. (Feb 2016) Patient information: Shoulder impingement syndrome (Beyond the Basics). UpToDate. Available from: http://www.uptodate.com/contents/shoulder-impingement-syndrome-beyond-the-basics.
Feil C and Morgan WE. The Importance of the Thoracic Spine in Shoulder Mechanics. 2009. Can be found at: http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=54622.
Henoch, Q. The Scapula and the Thoracic Spine: A Classic Love Story to Improve Your Overhead Position. Can be found at: http://www.jtsstrength.com/articles/2014/05/01/the-scapula-and-thoracic-spine-a-classic-love-story-to-improve-your-overhead-position/