Rotator Cuff Injuries And Irritations
Your rotator cuff is a group of muscles and tendons that help tether your shoulder into the socket and allow you to move it in a circular motion. Some two million people visit a doctor each year for rotator cuffrelated issues, according to the American Academy of Orthopedic Surgery . Most problems with the rotator cuff fall into two categories: tears or inflammation. Suspect a rotator cuff problem if you have pain or stiffness in your shoulder when you lift your arm above your head to brush your hair or when you reach behind your back. “You won’t be able to do a lot of things you want to do, such as put dishes in an upper cabinet, play tennis, or do garden pruning,” says Dr. Ramappa.
Rotator cuff impingement. A rotator cuff impingement happens when there is irritation, inflammation, or compression of the tendons or bursa in the shoulder. An impingement can be caused by an injury, but it can also just result from general wear and tear from daily life.
Rotator cuff tears. A tear in the rotator cuff will produce pain that is similar to an impingement but has one additional differentiating feature. “If the pain is associated with weakness, it is likely caused by a tear, and if you just have pain, it may only be a rotator cuff impingement,” says Dr. Ramappa.
Performing simple stretches two to three days a week can help keep your muscles flexible and reduce pain, provided your doctor approves.
Tips For Sleeping With Shoulder Pain
There are ways you can get a restful nights sleep despite your shoulder pain. Here are our best tips:
- Replace your mattress every 6 to 8 years.
- Consider physical therapy for shoulder pain
- Implement other conservative treatments during the day:
- Over-the-counter anti-inflammatory medications like ibuprofen provide pain relief so you can sleep.
- Seek medical advice if the pain doesnt improve or worsens
Treating Different Types Of Impingement
As I hope you can now see, to properly treat shoulder impingement you should differentiate between subacromial, coracoacromial, subcoracoid, and internal impingement.
Treatment is similar between these types of impingement. There is a bunch of overlap.
However, there are some differences:
- With subacromial impingement, you should be cautious with overhead activities that produce discomfort
- With the more anterior-based coracoacromial arch and subcoracoid impingement, you need to be cautious with elevation in more of a sagittal plane and horizontal adduction movements that produce discomfort
- With internal impingement, you should be cautious with excessive external rotation at 90 degrees abduction that produce discomfort
Notice that I said that produce discomfort for all three? The key here for me is that you should not work through discomfort or a pinch with impingement.
A pinch is the impingement of a sensitive structure!
Im not a fan of working through pain with shoulder impingement. That shows me that you either have a primary or secondary cause of impingement that hasnt been addressed. Trying to work through this could actually just irritate it more.
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Engage In Physical Therapy
Specific exercises and stretching moves are great at reducing pain and improving range of motion when shoulder impingement is involved. Patients can learn about these exercises when they engage in physical therapy. Not only will the exercises and stretches help them keep their shoulder moving properly, but these moves will also help to strengthen weakened muscles in the region. The patient’s general care provider may be able to give them more information on the types of exercises that will be most beneficial to the healing process, or they may be referred to a physical therapist.
Get the details on more ways to treat shoulder impingement now.
Tight Pecs And/or Lats
Tight pectoral muscles, a tight latissimus dorsi, or a combo of both lead to shoulder internal rotation and protracted scapulae and can also interfere with proper upward rotation of the scapulae. Check out this technique and learn how to effectively stretch your tight pecs and gain lasting mobility.
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Shoulder Impingement: 3 Keys To Assessment And Treatment
To make the treatment process for shoulder impingement a little more simple, there are 3 things that I typically consider to classify and differentiate shoulder impingement.
Each of these can significantly vary the treatment approach and how successful you are treating each person.
If you approach each patient with these 3 things in mind, you are going to do a much better job developing an effective treatment plan, versus just trying things and hoping they work.
Ive called this the corrective exercise bell curve in the past. If you just throw the same treatments at every person with shoulder pain, youll probably get lucky 20% of the time, make them worse 20% of the time, and simply waste your time the rest.
Lets dig in
Treatment For Shoulder Impingement Syndrome
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Try Physical Therapy To Rebuild Strength
Impingement makes moving your shoulder painful and challenging. Dr. Rovner often prescribes physical therapy to help you build strength and increase shoulder mobility as your injury heals.
Your physical therapist may focus on gentle, controlled exercises that strengthen the muscles in your shoulder, chest, and arm. This helps your rotator cuff move more smoothly, reducing pain and inflammation over time.
Shoulder impingement can take between six months and a year to completely heal. You may begin to return to normal activities in about two to four weeks, but check in with Dr. Rovner regularly so he can monitor your progress and pain level.
If your shoulder impingement pain isnt relieved with conservative treatments, Dr. Rovner may recommend shoulder surgery to repair your rotator cuff, if needed, and give it more space to move freely inside your shoulder.
Our team is here to help you find relief from shoulder impingement pain and get back to all your favorite activities. Contact us at 516-794-2990 to schedule an appointment with Dr. Rovner at one of our offices in Garden City, New York, or Fair Lawn, New Jersey.
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Nonsurgical Treatments For Shoulder Impingement
In most cases of shoulder impingement, nonsurgical treatment options will be recommended first. The goals of nonsurgical treatments are to:
- Reduce inflammation of the affected soft tissues
- Improve range of motion
- Improve supporting muscle strength and posture to increase the shoulders subacromial space
- Restore joint function1
Nonsurgical treatment options to relieve pain and improve joint mobility include:
- Rest. A person should avoid overhead activities and rapid movement, such as sports that require throwing or swinging. It is best to avoid frequent shoulder movement, however, total immobilization should be avoided. Immobilization can lead to weakness, stiffness, and worsening shoulder problems.
- Physical therapy. A licensed physical therapist can provide an individual treatment plan. A physical therapy treatment plan may focus on improving range of motion and strengthening weak muscles. A physical therapist may also recommend at-home stretches and exercises, which can help speed up recovery as well as prevent future shoulder problems.
- Nonsteroidal anti-inflammatory drugs . Some research suggests that 1 to 2 weeks of daily over-the-counter NSAIDs,2 such as ibuprofen or aspirin may help to reduce pain. Prescription strength NSAIDs may be recommended to maximize anti-inflammatory effects.
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Is Side Sleeping Bad For Your Shoulder
Unfortunately, side sleeping is bad for your shoulders. If you have shoulder impingement sleep with the affected shoulder up. The less pressure you place on the injured shoulder the better. If you must sleep on your side try leaning back to take some weight off of your shoulder. Put a pillow in between your legs to keep your hips in alignment and pressure off of the lower back.
Exercises To Avoid Worsening Shoulder Impingement Pain
Our shoulders are one of the most complex joints in our body. For that reason they can be quite susceptible to injury and inflammation.
If you are suffering from pain caused by shoulder impingement, the board-certified orthopaedic surgeons at Greater Rochester Orthopaedics will help you get back to living pain free. They specialize in providing comprehensive care to patients suffering from shoulder injuries in Rochester, NY. They will take the time to diagnose your symptoms and provide the best treatment plan for you. For more information please contact our offices at and schedule an appointment today!
The definition of impingement is to have an impact, to encroach or to collide. Overuse of the shoulder leads to swelling of the tendons which consequently collide or encroach on the upper shoulder bone and make it considerably painful to move. Lets look at specific activities and 4 exercises to avoid worsening shoulder impingement pain.
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Things You Can Do If You Have Shoulder Impingement
- Avoid things that make the pain worse avoid activities that involve repeatedly lifting your arm above your head for a few days or weeks. Ask a GP or physiotherapist when you can restart these activities.
- Do not stop moving your arm completely try to carry on with your normal daily activities as much as possible so your shoulder does not become weak or stiff. It’s usually best to avoid using a sling.
- Gently hold an ice pack wrapped in a towel on your shoulder for 15 to 20 minutes a few times a day.
- Take painkillers anti-inflammatory painkillers or paracetamol may help. A GP can prescribe stronger painkillers if needed.
Most Severe Shoulder Pain Can Be Treated
MY SHOULDER keeps me awake all night, doctor, said Tina, with a wince. I can barely lift my arm. Its been hurting for weeks.
Tina couldnt remember injuring her shoulder, which is common with shoulder pain. Pain at night when lying on the shoulder or turning over is also common, as is the inability to raise the arm above horizontal. Many patients come in because they can no longer raise their arms to comb or brush their hair.
In my practice, shoulder tendonitis is the most common cause of shoulder pain, although arthritis and a rotator cuff tear may also be involved. Often it takes an MRI to determine the cause.
Tendons are the nylon-like bands that connect muscles to bone. Often the tendons, ligaments and cartilage are all inflamed.
Shoulder pain produces a worsening cycle. It hurts to raise the arm, so the person doesnt do it. Without movement, the shoulder becomes stiffer and stiffer, producing more and more pain.
Most shoulder pain can be treated conservatively, without surgery.
The first treatment involves physical therapy. If you dont have access to a professional physical therapist, you can perform some useful therapy at home by gentle passive stretching of the shoulder.
Research suggests that gently stretching torn ligaments and tendons can help them heal more effectively. It is important to not use the shoulder muscles to lift the arm when stretching. This hurts, and can lead to greater inflammation. Rather, use other muscles to lift the arm.
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How To Kt Tape Shoulder Impingement
Fortytwo subjects with rotator cuff tendonitis/impingement randomly assigned to 1 of 2 groups:How does kt tape help shoulder pain?Icing after activity and rest are essential and should be combined with nsaids to combat inflammation and pain.If the theorized effects of kt can be demonstrated to be true, then the application of kt to the shoulder in individuals with sais may help minimize the causes of secondary impingement by inhibiting contraction of middle deltoid, facilitating contraction of the rotator cuff muscles, and provide cutaneous proprioceptive input which may promote better shoulder complex alignment and movement.
If you are the one with painful impinged shoulder, you will also need a helper to place on the tape for you.Impingement of the tendons of the rotator cuff, biceps, and soft tissue between the coracoacromial arch and the humeral head causes edema, inflammation, and shoulder pain .Kinesio taping and shoulder impingement syndrome case study full name:Kinesio taping compared to physical therapy modalities for the treatment of shoulder impingement syndrome by:
Remove about two inches of the tape backing on one end of the i strip and place it on the upper part of the front of your shoulder.Response to treatment was evaluated with the disability of arm, shoulder, and hand scale.Shoulder instability, or the resultant pain, can be a major problem on its own.Shoulder pain is a common musculoskeletal complaint.
What Are The Side Effects Of Impingement Syndrome Treatment
Upset stomach, indigestion, and headaches are the most common side effects of oral anti-inflammatory drugs. However, taking these medications after meals or with food can help reduce stomach upset. Anti-inflammatory drugs can also cause vomiting, constipation, and bleeding in the stomach , although these side effects are not common.
Side effects of cortisone shots depend on the dose and frequency of the injections. Unlike cortisone pills, occasional cortisone injections rarely cause serious side effects. Side effects that are much more common with cortisone pills include elevated blood sugar, a decrease in the body’s resistance to infection, weight gain, osteoporosis , thinning of the skin, cataracts, and raised blood pressure.
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Address The Root Cause
The next step is to address the root cause. As mentioned earlier, this lies in the various mobility restrictions created by a sedentary lifestyle or extended periods spent in poor posture. The exercises we did earlier may help alleviate pain and improve shoulder function in the short term. But it’s not enough. The truth is that a lack of mobility in key areas can cause you to continue having recurring shoulder issues in the long run. This is particularly because of the ways your body will compensate during exercises.
No amount of rotator cuff strengthening would truly fix the issue. This is why in step 2, you need to focus on mobilizing some of the tightened structure. And address the poor positions that likely caused the issue in the first place.
Now I have done quite a few articles on improving mobility and would highly suggest you take a look at the following to start:
Sleeping On Your Back
Sleeping on your back is recommended for just about everyone, including those with shoulder impingement. When you are sleeping on your back you are in a neutral position with minimal stress on your back, shoulders, and neck. Your spine is straight, creating less back pain and better posture. For added support place a pillow under your knees to create a gentle bend and less pressure on your hips. Some people also find that a small pillow under their shoulders opens their chest and pulls their shoulders back. Play around with different support tools to find what works best for you.
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Why Does Shoulder Pain Get Worse At Night
Your shoulder pain gets worse at night duet to your sleep position and decreased movement. If youre sleeping on your side or your stomach you are putting additional strain on your shoulders. Side sleepers put more pressure on their shoulders with their own body weight. Whereas stomach sleepers will have their shoulders slouch forward while they sleep causing shoulder pain and neck pain.
An additional reason why shoulder pain is worse at night is that you arent moving around as much as you are during the day. This decrease in movement can also cause your shoulder pain to be worse at night. Less movement can cause fluid to build up within the shoulder joint resulting in a sore shoulder.
What Pain Medications Are Prescribed For Bursitis
Bursitis is inflammation of a bursa, a fluid-filled sac where muscles or tendons must glide over bony surfaces. The most familiar locations include the knee, shoulder, hip and elbow. Excessive use of the joint can cause an acute attack, which manifests as extreme pain and limited range of motion. Bursitis may also be chronic, with of continual pain and joint stiffness. Your doctor may prescribe pain control using steroids, non-steroidal anti-inflammatory drugs NSAIDs or corticosteroid injections.
If you are experiencing serious medical symptoms, seek emergency treatment immediately.
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Causes Of Shoulder Pain
Rotator cuff tendinitis is among the most common cause of shoulder pains in addition to several other conditions. Rotator cuff tendinitis is a condition identified by swollen tendons. Another prevalent cause is shoulder impingement syndrome.
It’s a shoulder pain condition characterized by the rotator cuff getting caught on the humeral head and the acromion. Shoulder pain can also be caused by an unrelated injury in a different part of the body usually on the upper body part. Usually, the shoulder might emanate from the biceps or the neck.
Remember that shoulder pain can be extended or short-term, associated with other complications such as rheumatism or osteoarthritis. However, individuals with rheumatoid arthritis are at more risk of having shoulder pain due to swelling.
Other causes of shoulder pains are
- Frozen shoulder, also known as adhesive capsulitis
- Tearing of the rotator cuff muscles on your upper arm bone
- Shoulder arthritis
- Shoulder impingement
Alternatively, pain in the shoulders during sleep can be caused by varied conditions depending on your sleep positions and patterns.
Some of these causes are