Shoulder Impingement is a pretty common term we hear around the place and is often associated with another well known term – Bursitis (Inflammation of a Bursa). Shoulder impingement is one of the most common shoulder complaints in the community and is often used as an umbrella term to include a whole bunch of different issues and problems. It is also one of the most common reasons why folks head for shoulder surgery. There are times when surgical intervention is appropriate, but in my experience, this is in the lower proportion of people suffering from this sort of complaint. So I thought I would give a straightforward explanation around the anatomy of the shoulder in regards to this issue, some of the contributing factors, and what we as Physios look for in terms of managing the problem. Keep in mind, there is a wide spectrum when it comes to Shoulder Impingement and every case is different. I always recommend an accurate assessment and explanation from your Physio or health care professional to confirm your diagnosis. THE SUB – ACROMIAL SPACE This is where it all allegedly happens! It is a compact little space full of all sorts of important structures. If you tap yourself on the top of your shoulder, the bony ridge you feel is your Acromion Process. So, naturally, the sub acromial space is below this. (this is a Right Shoulder, looking from the front) In Clinic Physiotherapy Mosman Park In this small space we find the Supraspinatus Tendon (one of your rotator cuff tendons), a Bicep Tendon (there are two at the top end, this one is your “Long Head”), a Sub-Acromial Bursa (a buffer between the tendon and bone) and some other structures related to your shoulder capsule. So, there is not a lot of space left. James Weir Physiotherapist These structures are designed to be compressed with normal movement. The further your hand is from your body, typically this will add to compression, sideways tends to be moreso than front ways. Most of the time, these structures tolerate that well and all is normal. However, if there is a trauma, a prolonged abnormal load, or some sort of biomechanical change (this can be due to a LOT of different reasons), these structures can become more compressed than usual, which can end up being painful. Sometimes the structures can become swollen from inflammation which means more space is taken up and compression is increased before you even lift your arm. In some cases, bony structure can be part of the problem. Some people have a Type 3 Acromion which is more hooked. Sometimes, arthritic changes can mean bony spurs start impinging on the area too, which adds another element of compression.Be aware though, plenty of people have these situations, but absolutely no pain. So it isn’t a guarantee that bony shape or spurs need surgery. Mosman Park Physio I find in a lot of cases though, that the biggest contributing factors are more to do with postures and activities. People with lazy and weak shoulder posture can end up with more compression on this region also. SO, WHAT DO WE DO?Now, as I always say, getting a clear and accurate diagnosis on your specific situation is paramount, because, there really are a multitude of reasons why this impingement occurs. So, following a recipe for treatment is unlikely to work. One of the most important factors in treatment is relieving pressure on the sub acromial space, to allow the structures that are irritated an opportunity to recover.This can include;– Hands on Physio to loosen things up and improve positioning around the shoulder– Taping to help encourage particular shoulder positions– Exercise therapy to enhance particular muscle activity– Pain relief and medication is sometime necessary for more irritable shoulders– Taking a break from the activity, or activities that might be aggravating things– Modifying your activity or equipment you are working with can also be really helpful THE GOOD NEWSIn a huge percentage of cases, the problem is really manageable with the right approach. Surgical intervention should be reserved for people who have very irritable and ongoing issues that have not responded to a good course of non surgical treatment. Of course, this is always best discussed with a well informed Health Professional!Drop me a line if you have a question. In Clinic