Shoulder pain is common problem in patients of all age groups. The causes of pain and disability are many. Young and old have completely different spectrum of disease which may cause the same symptom i.e. pain, limited range of movement, .
The article focuses on shoulder pain in the young with special focus on Impingement syndrome. To understand this, we should know the basics of shoulder joint.
Shoulder is a ball and a socket joint (figure 1) where the ball moves in the socket with help of muscles attached on the ball. These muscles are inside the capsule of the joint. They are collectively called the rotator cuff muscles(figure 2). These perform the primary function of rotating the ball in the socket and perform complex functions in combination with the muscles around(outside) the shoulder joint.
|Name of muscle||Location (attachment)||Function|
|Subscapularis||In front of the ball||Internal rotates the ball|
|Supraspinatus||Over the top of the ball||Lifts(ABducts) the arm|
|Infraspinatus||Behind the ball||External rotation|
|Teres Minor||Behind the ball||External rotation|
The biceps muscle is along with these anchored to the socket of the shoulder joint on one end. Any movement of the elbow also involves activation of biceps along with it. The joint as a whole is enclosed in a capsule which has a thick layer of muscle cover over it.
What is Impingement ?
Impingement virtually means the entrapment in between two surfaces. The muscles of the rotator cuff attached to the ball, get frayed between the ball and upper part of the socket with repetitive movement. This is usually the result of either overuse, micro trauma or imbalance of the muscle around the shoulder joint.
When a patient raises his arm upto shoulder level the space between the shoulder blade/socket (acromion/glenoid) and the humeral head collapses and due to altered rhythm between shoulder blade and ball of socket, the socket rubs against the ball.
Once injury has set in, the injured muscle does not function the way it should and body recruits accessory muscles to come in play. This leads to pain in the neck and elbow of the patient in long term. The biceps being a part of shoulder complex becomes painful and restricts activities. Most commonly flexion and supination of elbow with weight in hand.
How to diagnose this?
Your sports medicine consultant or physical therapist will examine you after a brief history and give you an insight of what is probably wrong. This is accompanied by radiological tests to ascertain the exact cause of symptoms.
How to treat it?
In most acute and chronic problems of the shoulder joint first step involves making you pain free and putting you on physical rehabilitation. Patients may show variable responses to conservative treatment and may require other forms of adjuvant treatment.
What is the protocol in treatment of Shoulder impingement?
Steps are essentially:
- Medications and electrotherapy to reduce the pain
- Medications with exercises to achieve painless range of movement
- Exercises to gain synchrony between ball and socket
- Gain strength
- Resume normal activities.
Anytime during this sequence, if the patient complaints of persistence of symptoms or new symptoms, we always investigate the patient and may ask for a ultrasound (USG) guided intervention in the shoulder. This usually includes Steroid or PRP shots as per your physicians preference. In case that still fails to give relief, your doctor might ask you to undergo a diagnostic/therapeutic arthroscopy.
How can I avoid shoulder impingement?
Following proper form of exercise and prevention of injury is most important step. Most common exercises that lead to shoulder impingement include sports involving repeated ABduction and External rotation (like involved in a throw). Gym exercises like inclined bench press, front raises, dumbbell press more commonly lead to shoulder injuries.
The correct weight, correct posture, understanding elastic limits of body is very important. No two people looking alike have same bodily and mental capabilities.
What are the exercises to prevent shoulder impingement?
The following stretches and exercises may help prevent a shoulder impingement and maintain/improve scapular-kinetic rhythm.