Shoulder impingement syndrome

Brief about impingement syndrome

Impingement at the shoulder or more commonly known as bursitis is the inflammation of subacromial bursa which is a natural fluid filled cavity present to prevent friction. Anatomically, there are four muscles which encircle the shoulder to form a cuff so that shoulder’s stability is enhanced. Ligaments and bones of shoulder arch over this cuff. The shoulder bursa is present between this arch and the cuff.

Inflammation in this fluid sac occurs mainly when there are excessive shoulder movements and overhead abduction of the arm. 

Classification of shoulder bursitis

Depending upon the source of inflammation and presentation of symptoms, the impingement syndrome is classified into two parts. They are:

Primary bursitis

Naturally occurring conditions like osteoarthritis which subject to joint space narrowing to an extent that bursa gets irritated constantly are the primary and one of the most common reasons.

Daily activities like home chores requiring shoulder movements above the head, cleaning and reaching to high shelves, sports activities like volley ball or basketball result in continuous squashing of the cuff against the bony points and leads to bursa inflammation.

Secondary bursitis

Factors like poor posture, sleeping on one side. Lifting excess weight or repeated shoulder movements can cause Ligamentous and joint laxity in shoulder. With this the rotator cuff has to function more to hold the joint components together and thus it is most likely to get exhausted gradually initiating rubbing of arm bone against the cuff. This is also seen in the occasional players performing at higher intensities without prior practices.

What are the clinical manifestations of bursitis?

Bursitis typically causes a discomfort and pain at the tip of the shoulder. The shoulder muscles become overall weak and the patient’s active range of movements is found reduced. There is more difficulty in self activities like combing, using a towel, washing hair or extending the arm to pick something kept above head.

Apart from this, pain is felt at night or early morning to patients who prefer to sleep on one side.

Treatment of shoulder bursitis

Conservative management

This includes pain killers, non steroidal anti inflammatory medicines and steroid injection shots.

Physical therapy

The prime focus of physical therapy is on spontaneous pain reduction and neutralizing the effects of inflammation. Elimination of swelling and redness is done by use of ice therapy in form of air casts or ice cuffs.

Electrical modalities like ultrasonic waves and amplified TENS are given alongside to relax the adjacent tissues and promote healing. With this, the patient becomes more comfortable in starting an exercise program for shoulder strengthening.

Posture

An awareness of using the shoulder correctly, putting any heavy weight close to the body, reaching out to objects slowly and adequate methods of shoulder-spine alignment are effective ways of averting the pain.

Mobility

At the center of sports physical therapy, the productivity of arm is enhanced by resistive exercises using weights or thera bands along with use of pendulums, shoulder wheel and pulleys.