Shoulder pain is a common ailment that many people experience throughout their lives. Whether you’re an athlete or someone simply reaching for a cup on a high shelf, the intricacies of the shoulder joint can sometimes lead to discomfort and dysfunction. One such condition is internal shoulder impingement. In this blog post, we’ll delve deep into the world of internal shoulder impingement, shedding light on its causes, the signs to look out for, and the most effective treatment strategies.
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What Is Internal Shoulder Impingement?
Internal shoulder impingement is a condition characterized by the pinching or impingement of the rotator cuff tendons and the glenoid labrum within the shoulder joint. This typically occurs at the back (posterior) of the shoulder. Unlike external impingement, which involves the compression of the rotator cuff tendons beneath the acromion, internal impingement frequently affects overhead athletes like baseball pitchers and swimmers.
The repetitive overhead motions cause the rotator cuff tendons and the labrum to become entrapped between the humeral head (the ball of the ball-and-socket joint) and the glenoid (the socket). Over time, this repeated pinching can lead to rotator cuff and labral tears. Eventually, it causes pain and reduced range of motion in the shoulder.
What Are The Possible Causes?
Internal shoulder impingement can arise from a combination of factors, both intrinsic (related to the internal structures of the shoulder) and extrinsic (related to external forces or activities). Here are the possible causes:
Repetitive Overhead Activities
Athletes who frequently engage in overhead movements are at a higher risk. This includes baseball pitchers, tennis players, swimmers, and volleyball players. The constant repetition of these motions can cause wear and tear on the rotator cuff tendons and the labrum.
Glenohumeral Joint Laxity
Some people naturally have more laxity (looseness) in their shoulder joints. This hypermobility can cause excessive movement of the humeral head within the socket, leading to impingement.
Muscle Imbalances
Disproportionate strength or flexibility in the shoulder muscles can result in abnormal shoulder mechanics. For instance, a weak rotator cuff or scapular stabilizer muscles can cause the humeral head to move abnormally within the joint.
Scapular Dyskinesis
Abnormal movement or positioning of the scapula (shoulder blade) can alter the mechanics of the shoulder joint, potentially contributing to impingement.
Postural Abnormalities
Poor posture, such as forward head posture or rounded shoulders, can change the orientation of the shoulder joint, predisposing an individual to impingement.
Previous Shoulder Injuries
Past injuries, whether they were treated or not, can lead to changes in shoulder mechanics or result in scar tissue that predisposes an individual to impingement.
Age and Degenerative Changes
Although more commonly associated with external impingement, age-related degenerative changes can also contribute to internal impingement. As tissues in the shoulder age, they can become less resilient and more susceptible to injury.
While any one of these factors might increase the risk of internal impingement, it’s often a combination of issues that leads to the development of the condition. Proper assessment by a medical professional can help determine the underlying causes and guide appropriate treatment.
What Does An Internal Impingement Feel Like?
Internal impingement typically manifests as a deep, achy pain within the shoulder, especially in the back (posterior) region. The pain is most commonly experienced during specific arm movements, especially when reaching overhead, throwing, or when moving the arm into an externally rotated and abducted position, as in the cocking phase of a throw for athletes.
Some individuals may also report a catching or grinding sensation within the shoulder joint. As the condition progresses, there can be a noticeable decrease in shoulder strength and range of motion. This might be accompanied by feelings of stiffness or tightness.
Additionally, certain movements may exacerbate the pain, particularly when the individual lies on the affected shoulder or tries to push off from it. It’s worth noting that the symptoms of internal impingement can often mimic other shoulder pathologies. So, accurate diagnosis through clinical evaluation and imaging is crucial.
How Is It Diagnosed?
Diagnosing internal shoulder impingement involves a combination of clinical evaluation and imaging studies. Here’s how the condition is typically identified:
1. Medical History
The process starts by gathering a detailed medical history. The healthcare provider will ask about the onset, nature, and duration of the pain, specific activities that exacerbate the symptoms, any prior shoulder injuries, and the patient’s physical activity level or involvement in sports.
2. Physical Examination
- During the physical examination, the healthcare provider will:
- Assess the range of motion of the shoulder.
- Check for tenderness in specific areas of the shoulder.
- Conduct strength tests to evaluate the rotator cuff and other shoulder muscles.
- Perform special tests designed to replicate the symptoms of internal impingement. One common test is the “posterior impingement sign,” where the pain is provoked by maximally externally rotating and elevating the shoulder.
3. Imaging Studies
- X-ray: While X-rays primarily visualize bone and won’t show the soft tissues affected by internal impingement, they can be useful in ruling out other conditions, like bone spurs or fractures.
- Magnetic Resonance Imaging (MRI): An MRI provides detailed images of soft tissues and can reveal signs of damage to the rotator cuff tendons, labrum, and other structures in the shoulder. An MRI with contrast (also known as an MR arthrogram) can be especially helpful in visualizing labral tears.
- Ultrasound: This imaging technique can offer a dynamic view of the shoulder, allowing the examiner to visualize the rotator cuff and other structures while the shoulder is in motion.
4. Response to Treatment
In some cases, how a patient responds to conservative treatments, like physical therapy or anti-inflammatory medications, can provide additional clues about the diagnosis.
A definitive diagnosis often requires integrating the findings from the patient’s history, physical examination, and imaging studies. Proper identification of the condition is crucial.
How Do You Fix Internal Shoulder Impingement?
Treatment for internal shoulder impingement often starts conservatively and progresses to more invasive interventions only if necessary. Here’s a comprehensive approach to addressing this condition:
Rest and Activity Modification
One of the primary causes of internal shoulder impingement is the repetitive stress placed on the shoulder joint, especially in overhead movements. Consequently, the initial phase of treatment often revolves around giving the inflamed tendons and muscles a chance to heal. This might mean taking a break from sports or other activities that exacerbate the symptoms. Athletes, especially, might find this challenging, but pushing through the pain can worsen the condition.
Physical Therapy
Engaging in targeted physical therapy is a cornerstone of treatment for internal shoulder impingement. A licensed physical therapist will develop a personalized regimen to address specific deficits in shoulder function. Strengthening exercises will primarily focus on the rotator cuff and the muscles that stabilize the scapula (shoulder blade). This will ensure that the shoulder moves in a coordinated manner. Flexibility exercises help restore the range of motion and alleviate any tightness that might be contributing to the impingement.
Non-steroidal anti-inflammatory Drugs (NSAIDs)
NSAIDs, such as ibuprofen and naproxen, are often recommended to manage the pain and inflammation associated with internal impingement. By reducing inflammation, these medications can create a more conducive environment for healing. However, it’s essential to recognize that NSAIDs treat the symptoms and not the underlying cause. Prolonged usage should be monitored by a healthcare provider due to potential gastrointestinal, cardiovascular, and renal side effects.
Cold Compress
Cold therapy, or cryotherapy, can be an effective method for pain relief and reducing inflammation. Applying a cold compress to the affected shoulder constricts blood vessels, reducing blood flow and thereby decreasing inflammation. This temporary pain relief can be especially useful after activities that aggravate the shoulder. However, care should be taken to avoid direct contact with the skin to prevent cold burns.
Corticosteroid Injections
Corticosteroids are powerful anti-inflammatory agents. When conservative treatments don’t provide sufficient relief, injecting a corticosteroid directly into the shoulder joint can help reduce inflammation and provide temporary relief. However, it’s essential to approach this treatment with caution. While effective, repeated corticosteroid injections can weaken tendons over time and increase the risk of tendon rupture.
Surgical Intervention
For those who don’t find relief through conservative treatments, surgery might be the next step. Arthroscopic surgery is minimally invasive and involves inserting a small camera into the shoulder joint to visualize the structures and guide the surgical instruments. If there’s a physical obstruction or abnormal anatomy contributing to the impingement, arthroscopic decompression can reshape or remove the problematic structures.
Each individual’s experience with internal shoulder impingement can be unique. So it’s crucial to work closely with healthcare providers to determine the best treatment approach for the specific situation.
How Can I Prevent Internal Shoulder Impingement?
Certainly! Preventing internal shoulder impingement often revolves around strategies to maintain shoulder health and ensure that the joint functions optimally. Here’s how you can proactively work towards prevention:
Proper Technique and Mechanics
Especially for athletes and individuals involved in overhead activities, adhering to the correct technique is crucial. Whether it’s the form during a tennis serve, the arm motion during swimming, or the posture during weightlifting, maintaining proper mechanics can reduce undue stress on the shoulder joint.
Regular Strength Training
It’s vital to maintain balanced strength around the shoulder joint. Focusing on exercises that target the rotator cuff, deltoids, and scapular stabilizers can ensure that the shoulder moves harmoniously during activities.
Flexibility and Stretching
Regular stretching helps maintain shoulder mobility and can prevent the tightness that contributes to impingement. Incorporating daily stretches targeting the chest, back, and shoulder muscles can be particularly beneficial.
Warm-up Before Activity
Starting any vigorous activity with a proper warm-up prepares the muscles and tendons for the stresses they’ll endure. Warm-up exercises increase blood flow to the muscles, making them more flexible and less prone to injury.
Gradual Increase in Activity
Avoid jumping into intense activities or workouts without a build-up, especially if you’ve taken a break. Gradually increasing the intensity and duration of your activities allows your body to adapt and reduces the risk of overuse injuries.
Ergonomic Workspaces
For those who spend long hours at a desk, ensuring an ergonomic setup can prevent postural problems that contribute to shoulder issues. The monitor should be at eye level, and the arms should comfortably rest at a 90-degree angle while typing.
Stay Hydrated
While it might not seem directly related, staying hydrated ensures that your muscles and tendons function at their best. Dehydrated tissues can become more prone to injuries.
By integrating these strategies into your daily life and activities, you can significantly reduce the risk of developing internal shoulder impingement and other related shoulder pathologies.
Conclusion
Internal shoulder impingement, while a common concern especially among athletes and those engaged in overhead activities, is manageable with the right knowledge and approach. From accurate diagnosis to tailored treatments, and ultimately to preventive measures, one can effectively navigate this condition.
By prioritizing shoulder health and practicing good posture and techniques, individuals can ensure that their shoulders remain strong and pain-free. If you’re experiencing Shoulder pain, physical therapy for shoulder pain at PhysioMantra can help: Book an online physical therapy session.
