Commonwealth Sports Medicine

Does your shoulder hurt every time you throw, serve, or reach overhead?

If so you may have “Shoulder impingement Syndrome,” also known as “Subacromial Bursitis,” and “Tendonitis.” This common condition affects at least half of all overhead athletes at some point in their career.

To understand Impingement Syndrome, it helps to know the bones and a few muscles of the shoulder. The shoulder consists of 3 bones: the collar bone (clavicle); the arm bone (humerus); and the shoulder blade (scapula) (figure 1). The ball and socket of the shoulder moves in many directions; in fact, the shoulder is the most mobile joint of the body. The socket is shallow and the ball is relatively large. It’s analogous to taking a golf tee and balancing a basketball on top of it- an unstable situation.

This very mobile joint is supposed to be made stable by 4 small muscles collectively called the “rotator cuff.” Most people do not regularly strengthen their rotator cuff muscles and therefore have a “lose” or lax shoulder joint. Then we take this lax joint and stress it with throwing, hitting, and serving after a winter of doing no such things.

One of the four rotator cuff muscles, the spraspinatous, passes thru a tunnel in the middle of the shoulder (figure 2). This tunnel is narrowed every time you lift your arm up overhead (figure1).

The thin supraspinatus muscle gets crushed or impinged in the tunnel. When it gets crushed, it wants to get red, angry, and inflamed. The muscle tries to swell. However, because it is living in a tight tunnel, there is nowhere for the swelling to go. So it hurts. When it hurts, it tries to swell even more. Again, nowhere for swelling to go. You get the picture: impingement causes swelling, which causes pain, which in turn causes more swelling. This impingement is most severe when the rotator cuff is weak and the shoulder joint is lax.

Shoulder impingement typically causes pain down the outer side of the shoulder, half way to the elbow. The pain is worse with reaching overhead, and while trying to sleep. Your Sports Medicine doctor can put you through a series of maneuvers that can confirm the diagnosis of shoulder impingement. Once this diagnosis is made, there are a number of things that may be done to get you better. When recommending appropriate treatments, your Sports Med provider will take into account where you are in your athletic season. Here are some things that may be tried.
• Initially, decreasing overhead activities may help. Try to cross train by doing other drills and playing other positions.
• Ice three times a day for 20 minutes and anti-inflammatory medications may help decrease the swelling in the tight tunnel where the supraspinatus lives.
• A cortisone injection right into the tunnel around the supraspinatus may be tried.
• Strengthening and stretching the entire rotator cuff is important while healing occurs. Your rehab program will be costumed to your specific needs and to correct your specific weaknesses.
• Physical therapy modalities like ultrasound may be prescribed.
• Surgery may be discussed as a very last resort after getting no improvement with a good treatment program for over a year.