What is Shoulder Impingement Syndrome / Swimmer’s Shoulder?

Shoulder impingement is a common diagnosis seen in patients who complain of shoulder pain. It is commonly seen in competitive swimmers, but can be present in anyone. The shoulder is an extremely complex joint that is made up of 3 bones that join together to comprise the shoulder joint. Many ligaments and tendons are part of the shoulder joint that support it. Shoulder impingement occurs when the joint space is decreased either structurally or functionally. The proximity of bones or a tight capsule may lead to a tendon being pinched, causing pain. The capsule is a fibrocartilaginous balloon-like structure that surrounds the entire shoulder joint, protects it, and allows for a great deal of motion. The shoulder also contains a bursa within the joint. This bursa is a fluid filled sac that allows for smooth motion of the tendons. This bursa is another possible cause of pain in impingement if too much friction is applied to it and it becomes inflamed. In most joints of the body, the tendons run outside of the joint, but in the shoulder the tendons are inside of the joint surrounded by bones.

Because of their location and proximity to bones, ‘pinching’ of a tendon or increased rubbing of the bursa can occur between bones and tendons of the shoulder. This is what impingement is. This pinching of a tendon, usually a rotator cuff tendon, causes inflammation and pain. This diagnosis is common in athletes who participate in sports with a lot of overhead motions, particularly swimming. You will often hear this referred to as swimmer’s shoulder.

Shoulder Impingement Causes

Impingement is an overuse syndrome. It is so common in swimmers and athletes because of the mechanics of the joint with repetitive overhead motions. These motions have the chance of changing the mechanics of the shoulder over time leading to pinching of these structures. Sports related repetitive motion of the joint involving frequent overhead motions mostly cause this but Impingement can also occur as a result of ageing. Decades of these motions, even not sports-related, can cause changing mechanics of the joint. The formation of bone spurs within the joint is also a concern as they will allow for more bone in the area which can contribute to the pinching of tendons.

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Symptoms of Shoulder Impingement

The symptoms of this condition that an individual may experience with this condition are:

● Shoulder pain particularly with reaching overhead
● Feelings of stiffness and a dull ache rather than a sharp pain as in a tendon tear
● Increased pain with laying on the affected arm
● Shoulder weakness and loss of range of motion

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Shoulder Impingement Treatment

The treatment for true impingement syndrome will generally always be conservative unless it has progressed to the point that a tendon or other structure has torn leading to another diagnosis and possible surgery. Conservative approaches are:

● NSAIDs (non-steroidal anti-inflammatory) drugs
● Discontinuation of the offending activity
● Cortisone injection
● Physical therapy in order to stretch and strengthen the appropriate musculature and help to reverse any muscular imbalance that may have resulted

If the above approaches fail to reduce pain, there is a surgery that your doctor may consider that widens the space within the joint in order to relieve friction and pinching of the tendon.

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