The three most common types of shoulder pain – Part one

Shoulder Impingement

Shoulder impingement is the most common shoulder condition we treat at West London Physiotherapy, and summer is when it peaks. This irritating and painful condition can be treated successfully with a course of physiotherapy, but is much easier to treat if caught early. Here’s everything you need to know about shoulder impingement so that you know when it’s time to come and see us.

How is shoulder impingement diagnosed?

The onset of shoulder impingement is usually preceded by an increase in activity and load, which is why it’s more common in warm weather when people start playing more tennis or golf, or do more gardening. It’s most common in people 30+ years old and rarely seen in people in their 20’s. There’s rarely a specific trauma which brings on shoulder impingement, rather it gradually develops over time.

Shoulder impingement presents as a diffuse pain around the front, side and back of the shoulder. Pain can also spread down the side of the arm, but it rarely goes further down than the elbow. What differentiates shoulder impingement from other injuries is that, while movement is painful, it isn’t entirely restricted. If there’s pain with no specific trauma and no loss of movement, we’re usually dealing with shoulder impingement.

What causes shoulder impingement?

Shoulder impingement can involve irritation of a wide variety of tissues in the shoulder, but it typically includes bursitis, which is inflammation of a fluid-filled sack in the shoulder called the bursa. Bursae provide cushioning between bones, tendons and muscles to help joints move smoothly. When they become irritated, the joint may feel hot and uncomfortable while movement becomes difficult and painful. Another common component of shoulder impingement is damage to the rotator cuff tendon, which is responsible for stabilisation and rotation of the shoulder joint.

How is shoulder impingement treated? Do I need surgery?

Firstly, it’s worth noting that – as a first line treatment – surgery has been shown to provide no benefit over conservative management such as physiotherapy, which offers equal recovery for the patient without the additional costs and rehabilitation of surgery. Our treatment typically involves a gradual strengthening programme targeting the rotational strength of the shoulder joint and the muscles which connect the shoulder blade to the spine. The objective is to gently restore strength to the affected area without overloading the shoulder.

By 12 weeks patients should feel significantly better, but full recovery may time up to six months, particularly if there is significant damage to the rotator cuff tendons. If a patient fails to respond to physiotherapy the next step is to see one of our specialist shoulder consultants who can perform an MRI or ultrasound scan to identify if there is significant bursitis and provide cortisone injections to reduce the inflammation.The reduction in pain this injection provides gives us a window where the patient can comfortably perform our prescribed exercises, speeding up rehabilitation while still being far less invasive or costly than surgery.

Only when conservative measures have been exhausted should surgery be considered.

If you’ve developed any of the symptoms described above, you should come and see us for an assessment. The sooner we can intervene, the quicker and easier your rehabilitation from shoulder impingement will be.

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david wynne physiotherapist knightsbridge

David Wynne BSc (Physio) MSc (Sports and Exercise Medicine) MCSP MHCP

Musculoskeletal and Sports Physiotherapist, Research Lead at West London Physiotherapy