SHOULDER IMPINGEMENT & TENDONITIS
Injury
Description
This is one of the
most commonly occurring injuries in sports where the
arm is used in an overhead motion (i.e. swimming, baseball). The
pain is usually felt on the tip of the shoulder or
part way down the shoulder muscle. The pain is
felt when the arm is lifted overhead or twisted in
a certain direction. In extreme cases, pain will
be present all the time and it may even wake the injured
individual from a deep sleep. Throwing a baseball
overhand or working overhead may become impossible.
Anatomy
The tendons of the
muscles that life the arm, and the associated bursa
(fluid filled sac that prevents friction) go through
a very tight channel of bone (see diagram). When
the arm is raised, the channel becomes smaller and
makes the area very prone to inflammation. When
the arm is used overhead, it can bring the asymetric
bony prominence of the humerus to pinch or "impinge" against
the roof of the shoulder joint. This pinches
the rotator cuff and leads to tendonitis. If
left too long, it can actually tear the rotator cuff.
 Predisposing
Factors
-
Overuse: This
is the most common cause of the problem and the
result of repetitive overhead motions.
-
Weak muscles:
When the muscles are weak more force is exerted
on the tendons and bursea causing inflammation
and pain (tendonitis, bursitis).
-
Improper or inappropriate
swimming or throwing techniques.
-
Strenuous training:
One hard throw may start the problem.
-
Previous injuries
to the shoulder.
-
Loose shoulder
joint.
-
Calcium deposits.
-
Impingement of
osteophytes (bone spurs) on the shoulder joint
causing impingement syndrome.
Treatment
Rest: |
Use pain as your guide. You
are only aggravating the condition if you
continue your activity while experiencing
pain. In very bad cases, you should
refrain from using your arm for all daily
activities (lifting briefcase, opening doors). |
Ice: |
In the early, painful
stage, apply ice (frozen peas) to your shoulder
twice a day for 15 minutes. Always
apply ice for 15 minutes after any activity
using your arm. |
Range: |
When use of your arm
is limited, range exercises must be done
twice daily. Bend at the waist and
let your arm hang down. Then make large
circles with your arm. These pendulum
exercises will prevent your shoulder from
becoming stiff. |
Physiotherapy: |
The physiotherapist
will initially try to reduce the inflammation
in your shoulder. Later, therapy will
be designed to strengthen the shoulder to
prevent the problem from recurring. |
Medication: |
Your doctor may prescribe
anti-inflammation pills. These could
form a very important part of the treatment. |
Cortisone: |
In certain circumstances
an injection of cortisone into the shoulder
may be indicated. It is usually a secondary
treatment to supplement other therapy. After
an injection you should not attempt any vigorous
activities with your arm for a week to ten
days. |
Surgery: |
Sometimes surgery is
required to treat this condition. If
calcium deposits occur or impingement is
present, surgery may be necessary to remove
these problems. |
Risks: |
Stiffness, infection,
nerve, or blood vessel damage, bleeding,
persistent symptoms, phlebitis, anesthetic
problems, pneumonia, etc. MAKE SURE
YOU UNDERSTAND ALL OF THESE PRIOR TO SURGERY. |
Rotator Cuff Tears: |
If the muscle is found
to be torn at arthroscopy, an open incision
may be required to repair the rotator cuff. |
Sports
General
Principles
It is the overhead motion of the arm that
aggravates this condition. In severe cases all
sports using the arm should be avoided. When
you go back to your sport, go back slowly. Throw
easily and do not play for a long duration of time. Slowly
increase the strength of your arm and the intensity
of your game. In some sports you can avoid the
overhead motions (i.e. tennis, squash).
Throwing
Sports
Initially an underhand or side-arm throw will
be easier than an overhand throw. Warm up well. Throw
easily and gradually increase to harder throwing. Try
and maintain a smooth throwing motion. This will
use more of your body strength and relieve the pressure
on your shoulder.
Swimming
Breast stroke or side stroke will be easier
than front crawl or butterfly strokes. Sometimes
the back stroke causes less pain. Perform any
hard swimming (sprints) early in your swimming workout
before you are fatigued. Consult a swimming coach
to see if a change of your swimming style can help
relieve the problem.
Exercises
Do not attempt exercising while
the pain is severe. After the pain has subsided,
it is of utmost importance to strengthen the shoulder
muscles in order to prevent the condition from recurring. Exercise
will be taught to you by your physical therapist.
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