Shoulder Impingement: Diagnosis and Treatment
What is shoulder impingement?
Shoulder impingement is one of the most common causes of shoulder pain in both the general and athletic populations. The prevalence of shoulder impingement is exemplified by the number of different names associated with this diagnosis: Swimmer’s shoulder, Painter’s shoulder, Subacromial impingement syndrome are a few. This condition occurs when there are aberrant mechanics at the scapula and the glenohumeral joint creating pinching between the head of the humerus and the acromion. Symptoms of shoulder impingement can include pain at the front and side of the shoulder with any of the following motions:
- Reaching overhead
- Reaching behind the back
- Reaching across the body
- Overhead lifting and pushing
Common sports that are associated with and impacted by shoulder impingement include:
- Rock Climbing
Symptoms most often arise slowly, but can also be precipitated by a more acute injury such as a fall or strain. Treatment of shoulder impingement is almost entirely managed with conservative Physical Therapy care. Surgery is only indicated in extreme cases or if there are other drivers behind the pinching, such as rotator cuff tears, labral tears, or arthritic change; these are conditions that a Physical Therapist can help you to differentiate.
How to test yourself for shoulder impingement
A quick and fairly reliable test to see if your shoulder pain is consistent with impingement is called the “Yocum” test. It is performed by placing the hand of the involved shoulder on your opposite shoulder, then raising the elbow to horizontal. If not painful, resistance can be applied to this motion with the opposite hand. Pain is indicative of shoulder pathology, likely in line with shoulder impingement, but other problems can yield a positive result. Physical Therapy evaluation can aide in distinguishing the contributing factors to be addressed.
How to address shoulder impingement
Reducing impingement requires correction of the faulty mechanics. A common contributor is a lack of upward rotation of the shoulder blade. The “scapular assistance test” can tell you if your shoulder blade mechanics are at fault. If so, strengthening the upward rotators of the scapula is a good place to start in your rehabilitation process. Here is a quick video detailing the simple test: https://www.youtube.com/watch?v=BsVrYz_j7wo
One of the main upward rotators of the shoulder blade is the Serratus Anterior. The Serratus wall slide is one good exercise to help with this function. See the following link to learn how to fire your Serratus: https://www.youtube.com/watch?v=4M6whhALhp4
Shoulder impingement is a multifactorial puzzle and is best evaluated with a physical therapy evaluation. To ensure a thorough diagnosis and for additional information, schedule an appointment at our Seattle-based physical therapy office.
Dustin Steffan, DPT is a physical therapist in Seattle who specializes in orthopedic and sports rehabilitation.