Impingement Syndrome


impingement syndrome

What is Impingement Syndrome?

Impingement Syndrome is the diagnosis given for shoulder pain that is the result of tissues that get "pinched" or "impinged". This pinching occurs when the shoulder joint no longer stays centered in the socket as we raise our arm or use our shoulder.

The most common PLACE impingement occurs is between the humerus and the acromion process.

The most common TISSUES that get pinched are the biceps tendon, the supraspinatus tendon, and the subacromial bursa. Pinching of these structures leads to subsequent inflammation, fraying of the involved tissues, and ultimately the rupture of the tendons involved in very severe cases. Other related diagnoses are therefore: Biceps tendonitis, Rotator Cuff Tendonitis, Bursitis, and Rotator Cuff Tears.

Impingement of the rotator cuff tendon and bursa. They are being pinched between the head of the humerus (the ball part of the ball and socket) and the acromion.

What's Going Wrong In Impingement Syndrome?

1. Adhesion Buildup in Rotator Cuff.
The most common cause of impingement is inadequate rotator cuff function due to the buildup of adhesions in the rotator cuff. The buildup of rotator cuff adhesions prevents the rotator cuff from being able to hold the humerus in proper alignment as we use the shoulder, leading to impingement of tendons and bursa.
2. Strength and Flexibility Imbalances.
Strength and flexibility imbalance of the Scapula Muscles (the muscles that control shoulder blade position) may also lead to impingement. These imbalances most commonly occur with sports that over-emphasize one group of muscles. For example, weightlifters may tend to over develop the pectoralis minor, pulling the shoulder blade too far forward. When the shoulder blade is forward, it's position is very susceptible to impingement syndrome.
3. Structural Damage or Alteration.
  A) Rotator Cuff Tears (Complete Rupture) - A complete tear of the rotator cuff can cause severe impingement to occur, since the rotator cuff loses 100% of its function in such cases. For more information on this, refer to ROTATOR CUFF TEARS.
  B) Degenerative Joint Disease and Other Arthritides - Sharp bony spurs and loss of joint cartilage can cause pinching of tissues. For more information on how ART helps these conditions, refer to the section on DEGENERATION & OSTEOARTHRITIS.
  C) Genetic Alterations - Occasionally, there are genetic alterations in the shape of a person's acromion that will cause them to be more prone to impingement syndrome. These cases also respond very well to removing adhesions in the rotator cuff, BUT because they have a genetic weakness, certain shoulder "impingement positions" should be minimized or avoided. We can evaluate if you are at risk for these "impingement positions", and make recommendations for your exercise or training program accordingly.

Genetic, Structual Alterations that Cause Impingement

The highlighted area represents the "subacromial space", where some of the rotator cuff tendons reside.

Type I Acromion provides plenty of room for the rotator cuff tendons.

Type II acromion provides less room.

Type III acromion provide very little room for the rotator tendons, leading to a very high likelihood of impingement syndrome.

How Can ART Help Impingement Syndrome?

Treating the adhesions with Active Release commonly results in 90 to 100% reduction in pain, and full return to activity. Sometimes the last 10% of the pain only resolves with adding exercises to correct "strength and flexibility imbalance".

Common adhesions that are found in impingement include adhesions in the infraspinatus, subscapularis, and between their tendons and the deltoid. Adhesion in the muscles that control shoulder blade alignment are also addressed.

Following this with strengthening the rotator cuff, and smart training techniques helps prevent recurrence of the problem. Usually this condition can be treated without having to rest from the activity that caused it.

Success Stories of Those With Impingement Syndrome

Actual stories of actual patients at our clinic with Impingement Syndrome: