Shoulder Impingement

The hours spent in a kitchen can take their toll. It’s difficult to spend extra hours of your day to exert more energy to stay in shape. Oftentimes, a drink after your work shift is the one thing calling you…and you give in. And the next day, feeling sluggish and tired, you get the brilliant idea to attend a Crossfit class which starts out with 75 pull-ups, 60 push-ups and so on and so on. You put your body through the motions, but notice that toward the end of the workout you are starting to have pain lifting your arm.

The next day, it’s excruciating to lift your arm! Your best effort in trying to get in shape has backfired. And now, in the kitchen, you can barely perform your duties of lifting, mixing, beating and kneading. What happened?

Most likely, you now have an overuse/repetitive stress syndrome. The shoulder complex is actually 4 different joints with a multitude of muscles that have to work together. One group, called the rotator cuff muscle group contains one of the most common muscles that get overused. The rotator cuff consists of the supraspinatus, infraspinatus, teres minor and subscapularis muscles. The supraspinatus is one of the most important muscles in that it is responsible for the first 20 degrees of elevation as well as a secondary function of depressing the humeral head in the glenohumeral or shoulder joint. This is the primary muscle that gets stressed during repetitive overhead motions, like in baseball, football, volleyball, swimming and in the normal layperson that does too much upper body exercise without being appropriately conditioned for it.

Shoulder Impingement Syndrome is when the rotator cuff muscles get ‘pinched’ as your lift your arm overhead higher than 90 degrees (above shoulder height). Pain is felt with use, more specifically with lifting and reaching and of course, with any overhead motions. Pain is found in the shoulder and can radiate to the front and side of the upper arm. More severe symptoms will include pain at night, loss of strength or motion and difficulty with arm positions, especially behind the back.

Both a physician and a Physical Therapist can diagnose this condition in the office using special tests as well as your subjective history and complaints. To confirm the condition, an MRI can be ordered by a physician. It will look at the soft tissues involved to see if there is fluid and inflammation. X-ray will only look at the hard bone tissue, but can give you information on your structural build as well as if there are any other structural anomalies, like bone spurs.

Milea February 2019 728×90

Once diagnosed, non-surgical treatment includes: rest, non-steroidal anti-inflammatory medications, cold therapy, and Physical Therapy. Physical Therapy will include joint mobilizations to correctly align the joint, soft tissue mobilization to loosen and release the tight and inflamed tissues, strength and flexibility exercises, proprioceptive (body awareness) exercises, and sports or work specific functional exercises. Education is important in maintaining a good home exercise program to restore and maintain the health of the joint as well as prevent re-injury.

If conservative therapy does not work, the next step would be a steroidal injection to immediately calm the inflamed tissues. Physical Therapy is usually continued after this minimally invasive procedure.  If these two fail, then surgery is an option, with another course of Physical Therapy to follow.

Ask your local Physical Therapist for an Evaluation to help with this condition. It is better to get help sooner rather than later as this condition can become a nagging issue. Performing an exercise program to keep it at bay becomes a part of your normal routine, but it will keep your shoulder joint healthy, strong and flexible. You’ll be strong in the kitchen and in your workouts, whenever you choose to do them.