Subacromial impingement syndrome or “swimmer’s shoulder” affects the group of tendons inside your shoulder called your rotator cuff. When your rotator cuff tendons become irritated or inflamed, they rub on the shoulder blade and you feel pain, weakness and have a reduced range of motion. This usually occurs when you are involved in a repeated overhead activity, such as swimming.
What are the parts of a shoulder?
Two joints make up the shoulder. Your acromioclavicular joint connects your shoulder blade (scapula) to your collarbone (clavicle). This joint allows you to raise your arm above your head. Your glenohumeral joint is a ball and socket joint. It connects the top of your upper arm, your humeral head (ball), to part of the scapula called the glenoid (socket). It gives you the ability to rotate your shoulder in a circle and move it up and out from your body.
Soft tissue like ligaments, cartilage and tendons surround your glenohumeral joint. They help cushion the joint’s movement and keep the large humeral head in the shallow socket cavity.
Your rotator cuff is a group of tendons and muscles surrounding the top of the humerus to keep the head in place and allow your arm to rotate.
The deltoid muscle is the largest and strongest muscle in your shoulder. Tendons attach it to the clavicle and humerus, and it provides you the strength to lift your arm.
Your bicep tendon connects the muscle on the front of your forearm to the top of your shoulder socket and allows your forearm to rotate and your elbow to bend.
What causes a shoulder impingement?
Most cases of subacromial impingement are caused by overuse. Repeated overhead motion can cause inflammation, which makes the tendons swell and “catch” on your upper shoulder bone.
There are a few other less likely causes for shoulder impingement:
- Shoulder instability
- Curved or hooked acromion
- Previous shoulder injury
- Muscular weakness
How do I know if I have damaged my rotator cuff?
The main symptom of a subacromial impingement is pain due to overuse.
Other symptoms include:
- Weakness when lifting your arm
- Difficulty reaching up behind your back
- Tenderness in the shoulder
- Catching or grating of the muscle when you rotate or raise your arm
How is impingement syndrome diagnosed?
To determine whether you have subacromial impingement syndrome, your physician will ask you for a complete medical history, have you describe your symptoms and conduct a physical examination. An X-ray or MRI may be necessary to confirm the diagnosis and determine if there are other problems.
Does shoulder impingement require surgery?
Subacromial impingement syndrome can often be treated without surgery. Resting from the activities that caused your impingement and following your physician’s non-operative instructions will most likely lead to healing.
Some non-operative treatment options are:
- Over the counter pain medication
- Daily stretching in a warm shower
- Avoiding repetitive activities that move your shoulder
- Physical therapy
If your pain persists or gets worse, your physician may suggest a cortisone injection in your shoulder. If the cortisone injection isn’t effective, you may have a rotator cuff tear, which would most likely result in surgery. Your physician may perform an ultrasound, MRI or arthrogram to confirm the tear.
Once a tear is confirmed, surgery involves re-attaching the tendons to the humerus head, which is the “ball” in your shoulder’s ball and socket joint. Most rotator cuff repairs are done arthroscopically, which means your surgeon will use a camera and instruments to repair your tear through small incisions.
How do you prevent shoulder impingement?
If you use your shoulder excessively, for work, sports or daily life, shoulder impingement is pretty common. Smart training and proper recovery are the key ways to prevent impingement.
Here are six tips to keep your shoulder healthy:
- Train your rotator cuff muscles to keep them strong
- Rest instead of pushing through your pain
- Keep a regular training or workout schedule
- Make sure you are training all of the muscles in your shoulder
- Ice your shoulder after a hard workout to keep inflammation down
- Make sure your technique is correct for athletes
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