Impingement Of The Rotator Cuff?
With regard to the shoulder, impingement is the painful impact of bone against the rotator cuff tendon or bursa. A situation where the humeral head of the shoulder (the “ball” of the ball and socket joint) approximates the acromion (a part of your scapula that forms the roof of the shoulder joint) and soft tissues including the rotator cuff, biceps tendon or bura can get pinched between these uncompromising bony surfaces. In the ideal situation shoudler impingement should not occur during normal shoulder function, when impingement does occur, the rotator cuff tendons, bursa, biceps tendon may become inflamed and swollen. Inflammation and swelling associated with the rotator cuff is known as rotator cuff tendonitis. Impingement of the subacromial bursa and the subsequent inflammation of this small fluid sac in the shoulder is know as bursitis. Both subacromial bursitis and tendonitis of the rotator cuff can co-exist, or present independently. In this blog I will discuss impingement with regard to specifically rotator cuff impingement syndrome.
The Impingement Zone?
The impingement zone in the shoulder refers to postures and positions that can significantly narrow the subacromial space leading compression of the bursa or rotator cuff. Positions which the space below the acromion where the rotator cuff tendons pass and the bursa sits are compromised. Examples of positions that put the shoulder into the impingement zone include:
- When your arm is directly overhead or your head is behind your head.
- When your arm is at (or near) shoulder height, particularly when this is positioned more to the side of your body than in-front of your body.
Who Is At Risk Of Suffering Shoulder Impingement?
Some risk factors associated with rotator cuff impingement syndrome include:
- Smoking. Smokers carry in increased risk of rotator cuff impingement syndrome and this could be related to the fact that nicotine can affect sensory thresholds, impair vasculature to tendons and disturb tendon healing capacity.
- Sleeping position. Sleeping on your back with your hand/s behind your head as well as sleeping on your front or side with your arm up in forward elevation and hand pointing towards your face puts the shoulder in the impingement zone. When such sleeping positions are adopted for extended periods throughout the night it can be a significant risk factor / aggravating factor for people with shoulder impingement.
- Specific occupations. Professions requiring repeated overhead lifting activities, or extended periods working at or above shoulder height have high rates of rotator cuff impingement syndrome. Occupations in my experience that I have seen as being high risk include: painters and electricians.
Impingement syndrome is also more likely to occur in people who engage in physical activities that require repeated overhead arm movements, including but not limited to:
- Weight lifting
- Throwing sports (such as cricket and baseball)
- Soccer goalkeepers
Symptoms Of Rotator Cuff Impingement Syndrome?
When suffering with impingement of the rotator cuff tendons an individual may commonly experience some, or all of the following symptoms:
- Pain is generally experienced at the top of the shoulder, outside of the upper arm and sometimes extending down towards the elbow.
- Discomfort when lying on the painful side in bed, or when resting on the sofa.
- People will often experience a feeling of having pain and weakness when attempting to reach for or lift objects that are positioned at, around, or above shoulder height.
- A Painful Arc. The painful arc of shoulder movement is where pain is felt when your arm is moved through certain rages of the movement. Patients will report pain on elevating the arm between around 60-70 ° and 120 °. This relates to the catch of pain being just above and below shoulder height when moving the arm to overhead positions. Functionally this will mean there is often pain when putting your hand behind your head, brushing or washing your hair, hanging washing, reaching for something in a high cupboard…
- As the condition deteriorates shoulder pain may even be experienced when at rest even with the arm hanging at the side.
Diagnosing Rotator Cuff Impingement Syndrome
In most situations a physiotherapist will be able to diagnose rotator cuff impingement syndrome without the need for investigations. Following questions regarding the history and nature of symptoms, clinical examination of the shoulder utilizing some specific tests that can help identify (or exclude) impingement signs can be performed. If necessary the use of specific investigations may also help with diagnosis, in these situations assessment may include a request for X-rays, ultrasound scans, or an MRI. Such investigations can help identify the presence of swelling, degeneration, or tears in the rotator cuff, as well as pick up signs of bursitis. X-rays can uncover the presence of a hook type acromion, a hooked acromion has been shown to be a significant risk factor in shoulder impingement with individuals with a type II-III acromion having a higher incidence of rotator cuff problems.
Disclaimer: Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance regarding Rotator Cuff Impingement Syndrome should consult his or her orthopaedic surgeon, general practitioner, sports medicine specialist or physiotherapist.