Shoulder impingement syndrome treatment with 4 exercises

Last Updated on by Martin Kielema

Shoulder impingement syndrome is the most common shoulder problem seen by doctors. Fortunately, it’s a problem that is well treatable with some options.

There is no reason why you shouldn’t be able to recover.

But to be able to treat it the right way, you have to know the cause.

That’s because there are several different causes and treatment options for an impinged shoulder.

So I decided to write a complete overview of the possible causes and treatments for shoulder impingement syndrome.

That includes the right exercises, shockwave, and ultimately, surgery.

I also lead you through the diagnostic process because it sometimes looks very similar to biceps tendonitis.

The fastest way to relieve the pain is by putting this anti-inflammatory cream on your shoulder. It reduces the swelling of the tendon giving it more room in your shoulder. That will make it easier for you to do the exercises to cure it completely.

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In today’s post, you will learn:

  1. The anatomy of your shoulder
  2. What is shoulder impingement syndrome?
  3. What are the symptoms of shoulder impingement syndrome?
  4. How can I do a shoulder impingement test?
  5. How do I treat my shoulder impingement syndrome?
  6. Shoulder impingement surgery

The anatomy of your shoulder

shoulder anatomy

To be able to understand what the shoulder impingement syndrome is and what it’s possible causes are, you need to know a little bit about the anatomy of your shoulder joint.

3 Bones together for your shoulder joint:

 

    • Your humerus
    • Your scapula
    • Your clavicle

 

Your humerus is also known as the upper arm, your scapula or shoulder blade, and your clavicle or collarbone.

Your humerus and scapula don’t fit together. The head of your humerus is bigger than the surface of the scapula it attaches. That makes it an unstable joint by definition.

The reason for this is that your body sacrificed stability for mobility. Your shoulder joint is the most mobile joint in your body.
To compensate for the instability, several shoulder muscles try to keep the joint together. These muscles are known as the rotator cuff muscles.

There are four rotator cuff muscles:

 

    • Supraspinatus
    • Infraspinatus
    • Subscapularis
    • Teres minor

 

All these muscles run from the scapula and attach to the head of the humerus.  Two of these are essential in understanding the shoulder impingement syndrome. That is because your supraspinatus and infraspinatus run between your humerus and scapula.

For protection, your subdeltoid bursa covers them. Your bursa works like a little airbag. When the pressure on one of these muscles increases, your bursa fills with water to protect the muscles.

These structures can be one of the causes of shoulder impingement syndrome, which I will explain now.

What is shoulder impingement syndrome?

Now it’s time to show you what the shoulder impingement syndrome is.

Five structures can cause compression:

 

    • Supraspinatus muscle
    • Infraspinatus muscle
    • Calcification
    • Shoulder bursitis
    • Head of the humerus

 

Your supraspinatus muscle can be either irritated or ruptured. When it’s irritating, it swells up. When this happens, the tissue needs more space. So when you lift your arm, it’s compressed earlier between your humerus and scapula. That causes pain.

The second way your supraspinatus muscle can cause problems is when it’s completely ruptured. When this happens, it doesn’t use any space. It causes the humerus and scapula to come closer together. Now your humerus can hit the top of your scapula. That also creates pain and limited mobility.

Your infraspinatus can also become irritated. This way it also uses more space inside your shoulder joint. Just like your supraspinatus muscle, it gets compressed when lifting your arm.

When there is calcification in your supraspinatus muscle present, it can become compressed inside your shoulder joint when lifting your arm. However,  this doesn’t always have to be the case. It depends on the position and size of the calcification as well as the available space inside your shoulder joint.

Also, shoulder bursitis causes shoulder impingement syndrome. When you have bursitis, the bursa is inflamed and full of water. It takes up all the space in your shoulder joint when this happens though you are usually unable to move your arm at all and also have pain in rest.

The last possibility is that the space between your shoulder blade and humerus head is insufficient. When this happens your humeral head runs into your shoulder blade when lifting your arm. There are multiple possible reasons for this, which I will explain to you now.

Overuse of your shoulder or a fall on your shoulder usually cause these problems

What are the symptoms of shoulder impingement syndrome?

The shoulder impingement syndrome symptoms are different for each of the various causes.

When the supraspinatus muscle is involved, you can tell it by the following symptoms:

 

    • The first symptom is a pain at the front side of your shoulder. This pain has a very nagging character.
    • The second symptom is that this pain radiates down your arm, at the front side. Usually, this radiation stops your forearm halfway.
    • The third shoulder impingement symptom is a pain when lifting your arm above 80 degrees sideways.
    • The final symptom for impingement syndrome is pain during external rotation of your arm. This pain is especially prominent when you try to grab something that lies next to you.

 

Also, to lie on your shoulder is painful.

When your infraspinatus muscle is involved, one of the above symptoms is different:
Now the pain radiates at the outer side of your arm to your hand.

When you have calcification in your shoulder, your shoulder feels more stuck then painful when lifting your arm.

When you’ve ruptured your supraspinatus muscle, you’re suddenly in a lot of pain, right after you fell on your arm. Also, you are unable to lift it without raising your shoulder.

Lastly, when you have shoulder bursitis, you’re in a lot of pain and unable to lift your arm at all in any direction. You’ll even have a lot of pain when you’re not moving your arm.

The symptoms, together with the cause, will give you a good idea of what the problem is.
There are also a few tests that you can do to determine if you have a shoulder impingement syndrome. You can find them in the next chapter.

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How can I do a shoulder impingement test?

There are three different shoulder impingement tests to determine if you suffer from the shoulder impingement syndrome or not. If these three tests are positive, and your symptoms also look like shoulder impingement syndrome, you can be pretty sure that you have it. Here I’ll describe the three criteria for you.

Shoulder impingement test 1

The first shoulder impingement test is the Neer Test. It tests if there is enough space in your shoulder to function correctly.

To perform this test, stand up with your arm fully extended, hanging next to your body with your hand palm facing forward. Your thumb locates on the outer side.

Now let someone lift your arm. Keep your arm extended. You should be able to perform this moment with little to no pain.

Neer Test fase 1

Now repeat the same movement, but this time have your arm fully rotated internally. So turn your arm until the palm is facing forward again, but now you already feel more tension in your shoulder.

Let someone lift your arm again fully extended. When this causes significant pain, and you’re not able to fully raise your arm, the test is considered positive.

Neer Test fase 2

Shoulder impingement test 2

The second shoulder impingement test is Hawking’s test. It is another test if there is enough room in your shoulder joint or not.

To perform this test, lift your arm to 90 degrees, so it is in front of you. Now also bend your elbow.

Third, push your hand palm away with your other hand, so that your arm rotates internally. Keep your forearm in the same position. When this causes pain in your shoulder, the test is considered positive.

Hawkings Test

Shoulder impingement test 3

The third shoulder impingement test is called the empty can test. It tests your supraspinatus tendon for muscle pain or weakness. The supraspinatus tendon is one of the muscles in your shoulder that impinges.

To perform this test, lift both arms to 90 degrees. Also, move both arms a little bit to the outer side, so they’re forming a V-shape. Now rotate both arms, so your thumbs face the ground.

Let someone push both arms down while you keep your arms in the same position. When you feel pain or weakness in your affected shoulder, compared to your healthy joint, the test is considered positive.

When these three shoulder impingement tests are positive, you can be pretty sure that you’re suffering from shoulder impingement syndrome. Luckily for you, I will show you four shoulder impingement exercises to relieve your shoulder pain within a few weeks. So don’t wait any longer but let’s start right away.

Empty Can test

Shoulder impingement syndrome treatment with four exercises

The cure for your shoulder impingement syndrome depends on the cause of it. But for all reasons there are three general things you have to do:

 

 

Especially when you have shoulder bursitis, anti-inflammatory drugs will reduce inflammation, swelling, and pain. It will usually take about five days. After those five days, the pain and limitation reduce significantly.

When the pain reduces enough, you can start with the shoulder impingement exercises I’ll discuss later.  Many doctors will suggest a corticosteroid injection to relieve symptoms. A study shows, however, that corticosteroid injection is not effective in the long term unless you combine it with exercises.  It can even damage the tendons inside your shoulder joint. Therefore I would not recommend it.

When the problem is a supraspinatus or infraspinatus tendinitis, you should perform three specific exercises. That will also help you when the mobility of your neck is involved.  These exercises are designed to restore the movement of your neck, your shoulder, and to repair the affected muscle. Let’s dive right into different activities.

Shoulder impingement exercise 1: Increase the mobility of your neck

The first shoulder impingement exercise is designed to increase the movement of your neck. Earlier I explained why a healthy neck is so important in solving shoulder impingement syndrome. That’s why we start with this exercise.

Perform the exercise as follow:

 

    • Wrap a towel around your neck
    • Take with your left hand the right side of the towel and with your right hand the left side
    • Now lift the hand that is in front up until the towel is at the same height as your cheek
    • Now pull with your arm and the towel your head in the full rotation to the side
    • Repeat this ten times and then change to the opposite side by changing your hands
    • Finally, grasp the towel normal and lift your arms and look up at the same time

 

On the video on our YouTube channel, you can accurately see how to perform the exercise

Perform this exercise twice a day, both in the morning and in the evening.

Shoulder impingement exercise 2: Increase the space within your shoulder

The second shoulder impingement exercise is designed to increase the area inside your shoulder joint. When you’re suffering from shoulder pain for a more extended period, the capsule of your shoulder starts to get irritated as well. It causes the capsule to stiffen. That results in reduced mobility of your shoulder and less space inside your shoulder joint.

The mobility of your shoulder must be restored to increase the space inside your shoulder joint. You can do this by stretching the capsule with the following exercise.

Perform the exercise like this:

 

    • lay down on your painful shoulder
    • Lift your arm into a 90 degrees angle with your body
    • Grasp with your other hand the hand of your painful shoulder
    • Now push the painful side down towards the ground
    • Hold this for 10 seconds and repeat it several times

 

On the video on our YouTube channel, you can accurately see how to perform the exercise.

 

Perform this exercise twice a day, both in the morning and in the evening.

Shoulder impingement exercise 3: Increase the strength of your infraspinatus muscle

The third shoulder impingement exercise is to restore the power and function of the affected tendon and muscle. When you train the muscle, it will start to repair itself again. The tendon impinged the most is the infraspinatus tendon. Therefore this third exercise is designed to train your infraspinatus muscle. When the muscle fully repaired, your shoulder pain is gone.

Perform the exercise like this:

 

    • Lay down on your healthy side with your painful arm pushed in your side
    • Keep your arm flexed in 90 degrees
    • Now rotate your arm so that your hand faces the ceiling
    • Repeat this ten times and do this three times

 

On the video on our YouTube channel, you can accurately see how to perform the exercise.

Perform this exercise twice a day, both in the morning and in the evening.

Shoulder impingement exercise 4: Increase the strength of your supraspinatus muscle

The last activity is designed to train your supraspinatus muscle. The function of your supraspinatus is the abduction of the arm. However, when the pain in your shoulder is too heavy, training abduction will be too painful. That’s why we’ll start with lifting your arms forward. When you can do this quickly, you can begin training abduction of your shoulder. You can do this by raising your arms sideways.

On the video on our YouTube channel, you can see exactly how to perform the exercise.

Perform this exercise twice daily, in the morning and the evening.

If you find our information helpful and would like to support us, you can donate here through PayPal or leave a review on Google or Facebook.

Also, make sure to subscribe to our YouTube channel for more video’s.

Shockwave therapy

When the cause of your shoulder impingement syndrome is calcification, you can add shockwave therapy to the shoulder impingement treatment. A trained physical therapist can perform the procedure.

Shockwave therapy uses a device like a little drill. It drills the calcification into small pieces. That will help your body to reabsorb the calcium so that the calcification disappears.

The treatment is usually quite painful and will take about 6-9 times.

The results, however, in our practice, are excellent.  With the use of shockwave therapy, we’ve been able to help patients with their shoulder impingement syndrome after years of pain.

shockwave therapy shoulder impingement syndrome

Shoulder impingement surgery

The surgery is usually done arthroscopically. The surgeon makes two small insertions through which the arthroscope enters the shoulder. Through the arthroscope, the surgeon inspects your shoulder to find any reasons for your shoulder impingement syndrome. That could be loose bodies, calcification, or tears in the tendon. Also, deformation of your acromion can be a reason for your impingement syndrome.

When the surgeon has determined the reason for your shoulder impingement syndrome, the surgeon will start to treat the problem. It can be done by removing the loose bodies or calcification, shaving of the acromion or repairing the tendon. That depends on the reason for your shoulder impingement syndrome. The shoulder impingement surgery will take somewhere between 1 and 2 hours.

Shoulder impingement surgery recovery time

The shoulder impingement surgery recovery time usually takes six weeks to 3 months. The first days using pain medication is recommended. After about a week, most pain will disappear. It’s essential to keep moving your fingers, wrist, and elbow to prevent them from becoming stiff.

During the first four weeks, you’re only allowed to perform small activities below shoulder height. After four weeks, you can slowly start doing your overhead activities. Your therapist will advise you on exercises to train your shoulder after the surgery.

Conclusion
Shoulder impingement syndrome is very well treatable with a series of exercises. However, sometimes, shoulder impingement surgery is required to get you entirely pain-free. So when the activities don’t work for you, you should contact your doctor for further treatment.

If you have any questions left, feel free to send an e-mail to [email protected]