Shoulder Impingement & Tendonitis |
 Injury
Description
This is one of the most commonly
occurring injuries in sports where the arm is used in an overhead
motion (i.e. swimming, baseball). The pain is usually
felt on the tip of the shoulder or part way down the shoulder
muscle. The pain is felt when the arm is lifted overhead
or twisted in a certain direction. In extreme cases,
pain will be present all the time and it may even wake the
injured individual from a deep sleep. Throwing a baseball
overhand or working overhead may become impossible.
Anatomy
The tendons of the muscles
that life the arm, and the associated bursa (fluid filled sac
that prevents friction) go through a very tight channel of
bone (see diagram). When the arm is raised, the channel
becomes smaller and makes the area very prone to inflammation. When
the arm is used overhead, it can bring the asymetric bony prominence
of the humerus to pinch or "impinge" against the
roof of the shoulder joint. This pinches the rotator
cuff and leads to tendonitis. If
left too long, it can actually tear the rotator cuff.
 Predisposing
Factors
-
Overuse: This is the
most common cause of the problem and the result of repetitive
overhead motions.
-
Weak muscles: When the
muscles are weak more force is exerted on the tendons
and bursea causing inflammation and pain (tendonitis,
bursitis).
-
Improper or inappropriate
swimming or throwing techniques.
-
Strenuous training:
One hard throw may start the problem.
-
Previous injuries to
the shoulder.
-
Loose shoulder joint.
-
Calcium deposits.
-
Impingement of osteophytes
(bone spurs) on the shoulder joint causing impingement
syndrome.
Treatment
Rest: |
Use pain as your guide. You
are only aggravating the condition if you continue
your activity while experiencing pain. In
very bad cases, you should refrain from using your
arm for all daily activities (lifting briefcase,
opening doors). |
Ice: |
In the early, painful stage,
apply ice (frozen peas) to your shoulder twice
a day for 15 minutes. Always apply ice for
15 minutes after any activity using your arm. |
Range: |
When use of your arm is limited,
range exercises must be done twice daily. Bend
at the waist and let your arm hang down. Then
make large circles with your arm. These pendulum
exercises will prevent your shoulder from becoming
stiff. |
Physiotherapy: |
The physiotherapist will
initially try to reduce the inflammation in your
shoulder. Later, therapy will be designed
to strengthen the shoulder to prevent the problem
from recurring. |
Medication: |
Your doctor may prescribe
anti-inflammation pills. These could form
a very important part of the treatment. |
Cortisone: |
In certain circumstances
an injection of cortisone into the shoulder may
be indicated. It is usually a secondary treatment
to supplement other therapy. After an injection
you should not attempt any vigorous activities
with your arm for a week to ten days. |
Surgery: |
Sometimes surgery is required
to treat this condition. If calcium deposits
occur or impingement is present, surgery may be
necessary to remove these problems. |
Risks: |
Stiffness, infection, nerve,
or blood vessel damage, bleeding, persistent symptoms,
phlebitis, anesthetic problems, pneumonia, etc. MAKE
SURE YOU UNDERSTAND ALL OF THESE PRIOR TO SURGERY. |
Rotator Cuff Tears: |
If the muscle is found to
be torn at arthroscopy, an open incision may be
required to repair the rotator cuff. |
Sports
General Principles
It is the overhead motion of the arm that aggravates
this condition. In severe cases all sports using the
arm should be avoided. When you go back to your sport,
go back slowly. Throw easily and do not play for a
long duration of time. Slowly increase the strength
of your arm and the intensity of your game. In some
sports you can avoid the overhead motions (i.e. tennis, squash).
Throwing Sports
Initially an underhand or side-arm
throw will be easier than an overhand throw. Warm
up well. Throw easily and gradually increase
to harder throwing. Try and maintain
a smooth throwing motion. This will use
more of your body strength and relieve the
pressure on your shoulder.
Swimming
Breast stroke or side stroke will be easier than
front crawl or butterfly strokes. Sometimes the back
stroke causes less pain. Perform any hard swimming
(sprints) early in your swimming workout before you are fatigued. Consult
a swimming coach to see if a change of your swimming style
can help relieve the problem.
Exercises
Do not attempt exercising while the pain
is severe. After the pain has subsided, it is of utmost
importance to strengthen the shoulder muscles in order to prevent
the condition from recurring. Exercise will be taught
to you by your physical therapist.
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