If you’re having difficulty elevating your arms above your head, then you may have a shoulder impingement, rotator cuff tendinitis, or a torn rotator cuff. The cause of this injury is repetitive motion from such actions as painting, weight lifting, sleeping on your side, shoulder injury while playing a sport (swimming, tennis serve, throwing a baseball/softball/football) or preventing yourself from a fall. For more information about shoulder pain, see these articles: Arthritis, Rotator Cuff Tendonitis, Rotator Cuff Tears, Shoulder Dislocation, Shoulder Separation, Shoulder Sprain and Strain, SLAP Tear (Superior Labrum Anterior Posterior Tear), Shoulder Fracture, and Shoulder Cartilage Tears.
In this article, I will discuss shoulder impingement. Shoulder Impingement occurs when the arm is elevated above the head so that the space between the acromion and rotator cuff narrows, causing the acromion to rub against the tendons and the bursa. If this occurs, patients may experience severe pain that radiates from the shoulder down the arm and stops at the elbow with possible swelling in the front portion of the shoulder. The shoulder may be very tender to the touch. Patients may have decreased shoulder/arm mobility and problems elevating the arm to eat. They may complain that the arm feels heavy, weak, stiff, and painful when lowered. The pain may increase at bedtime, there by causing difficulty sleeping on the affected side.
If you are experiencing any of these symptoms, please contact your primary care physician for a shoulder X-Ray to assess the bone structure and an MRI/CT to assess soft tissue, tendons, fluid buildup (possible bursitis), and possible tears. The best treatment plan for shoulder impingement is to reduce the pain and restore the affected shoulder function. Shoulder Impingement is treatable with rest, ice packs and heating pads for 20 minutes four times per day interchangeably, and physical therapy. NSAIDS (Advil, Aleve, Naproxen, ibuprofen, etc.) are effective for managing the pain and swelling. Steroid shoulder injections may also be effective. Depending on the results and the level of pain, a referral to an orthopedic surgeon may be necessary.
Shoulder Anatomy
The shoulder is formed when the humerus, collar bone (clavicle), and scapula join. The rotator cuff holds the humerus in place. The muscles that form the shoulder are the supraspinatus, infraspinatus, tres minor, subscapularis, and the deltoid. There are four rotator cuff tendons and two biceps tendons that make up the shoulder. These tendons connect the deep layers of the muscles to the scapula and humerus and provide support to the glenohumeral joint. The supraspinatus tendon is the most affected tendon due to overuse and trauma. The supraspinatus muscle is responsible for lifting the arms out to the side. An injury to this muscle can result in possible rotator cuff tear(s). Overuse can lead to shoulder (subacromial) impingement.
References
Alila Medical Media. (2020). Rotator Cuff Anatomy, Labeled. [Illustration]. Retrieved from https://www.shutterstock.com/image-illustration/rotator-cuff-anatomy-labeled-147943874
Alila Medical Media. (2019). Shoulder bursa, bursitis. [Illustration]. Retrieved from https://www.shutterstock.com/image-illustration/shoulder-bursa-bursitis-122298685?src=LgujqAxYpFEk2V8pW5kcBw-1-8
American Academy of Orthopedic Surgeons. (2019). Shoulder Pain and Common Shoulder Problems. Retrieved from https://orthoinfo.aaos.org/en/diseases–conditions/shoulder-pain-and-common-shoulder-problems/NIH. (2019). Rotator Cuff Problems. Retrieved from https://medlineplus.gov/ency/article/000438.htm
Udaix. (2020). Shoulder Joint of the Human Body. [Illustration]. Retrieved from https://www.shutterstock.com/image-vector/shoulder-joint-human-body-anatomy-infographic-699043855