An achy or painful shoulder can be one of the most annoying pains you can have as it can affect your everyday activities like driving, sleeping, putting the washing out and cleaning your teeth. One of the most common types of shoulder pain is more commonly known as Shoulder impingement or Subacromial pain syndrome (SAPS), which involves the pinching of the tendons at the tip of the shoulder.

Anatomy:

The shoulder joint, although a simple ball and socket joint is actually rather complex. The socket that houses the ball is quite shallow and flat meaning there is not too much stability in the joint itself and relies on the surrounding musculature to support the joint.

In most movements involving the shoulder, the biggest muscle on the side of the shoulder (deltoid) contracts to raise the arm and by doing so wants to force the ball into the socket. Being a shallow flat socket, the ball is likely to move too far up in the socket. What stops this from happening are the rotator cuff muscles (small group of 4 muscles) by adjusting their tension they pull the ball into the middle of the socket.

What is the cause?

Shoulder impingement can occur when there is an imbalance of the opposing forces that help raise the shoulder and keep the ball in the socket. If there is a decrease in the pull from the rotator cuff (weakness), the small space (subacromial space) that lies above the joint becomes narrowed. This can cause pain, swelling, bruising of the rotator cuff or the bursa (fluid filled sac that sits on top of the tendons).

There are many contributing factors such as:

• Postural abnormalities (rounded shoulders)
• Repetitive activities (especially those that are overhead)
• Anatomical abnormalities of the acromion or other bony spurs within the shoulder joint
• Acute trauma such as a fall or pull of the arm
• Faulty exercise equipment/sporting techniques
• Muscle imbalances

What are the symptoms?

• Pain felt in the top of the shoulder joint and/or upper arm
• Symptoms often worsen when elevating the arm above shoulder height
• Pain can be constant or intermittent
• Pain normally develops gradually
• Often the pain decreases when the arm reaches vertical
• Initially the shoulder may only become painful following exercise, or the next morning after excess shoulder activity
• Stiffness/tightness may also be associated with the pain
• Pain with lying on affected side

Symptoms can lead to decreased shoulder mobility, weakness, poor sleep, neck and upper back stiffness/pain. The symptoms can quite quickly begin to affect work and daily activities of function.

Management:

Subacromial pain does not typically go away on its own if the cause is not addressed. Therefore, it is important to have your shoulder thoroughly assessed by a physiotherapist. A thorough assessment can determine what the contributing factors are. Once these factors are known, an effective individualized treatment/ management plan can be put into action.

Some typical treatment techniques are:

• Postural re-education and exercises
• Stretches
• Strengthening exercises and scapular stabilisation
• Spinal mobilisations
• Dry needling
• Massage
• Functional task modification
• Safe return to activity

If the diagnosis is in fact shoulder impingement please be assured there are many great treatments that your Physio can help you with.

At Flexed we offer Physiotherapy, Massage, Pilates and Functional Training options to assist with creating the best treatment and management plan to suit the individual.

Erin Gleadell

Physiotherapist

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