Common Causes of Shoulder Pain

Impingement

The shoulder is the most mobile joint in the body. It requires multiple muscles and joints to work in harmony to allow normal function. Most patients presenting with shoulder pain have problem lists that require skilled intervention. Restoring glenohumeral rhythm is not an intuitive process for most patients and usually requires treatment components that cannot be addressed independently. These problems rarely fix themselves.

Having a painful shoulder can impact everything from sleeping to any activity that requires overhead motion. Shoulder pain is a commonly reported reason for having to miss work. Abnormal mechanics tend to worsen with time, which frustrates most patients. This makes them a highly motivated patient population and places a premium on having treatment options that impact pain quickly, as it is paramount to improving shoulder function.

Shoulder impingement syndrome is one of the most common shoulder conditions seen in clinical practice, accounting for 44-65% of all shoulder complaints, according to research. It occurs when the subacromial space narrows, causing irritation and inflammation of the rotator cuff tendons as they move through this space. This can result in rotator cuff tendinitis, leading to pain and a limited range of motion in the shoulder. The symptoms of shoulder impingement often overlap with those of rotator cuff tears, so a thorough evaluation is essential before developing a treatment plan. Diagnosis is typically made through a physical examination.

Overuse or repetitive overhead activities, such as throwing, swimming, or painting, can contribute to shoulder impingement. Improper scapular mobility or muscle imbalances make impingement particularly common in athletes and individuals with physically demanding jobs that involve frequent overhead motions.

Contributing Factors

Before exploring treatment options, it’s important to understand three key factors that contribute to shoulder impingement:

Poor Posture: Poor posture can affect scapular mechanics and lead to restrictions in the anterior soft tissues, making individuals more susceptible to impingement. This is especially common among people with desk jobs, particularly those who spend long hours using a keyboard.
Muscle Weakness and Imbalances: Muscle weakness, poor endurance, or strength imbalances in the rotator cuff or scapular muscles can cause improper positioning of the glenohumeral joint during overhead movements or under load. This can result in irritation of the tissues beneath the acromion.
Bone Spurs: Bone spurs in the shoulder joint can contribute to the narrowing of the subacromial space. A recent study found that 68% of adults in their late 50s, regardless of whether they had rotator cuff tears, had acromial spurs, with the incidence increasing with age. The study also highlighted that individuals with bone spurs are at a higher risk of developing full-thickness rotator cuff tears.

Additionally, trauma or injury to the shoulder, such as a fall or sudden impact, can also contribute to impingement.

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