Shoulder Impingement – Have you got a bursa?

Shoulder pain is quite common throughout society with up to two thirds of the population suffering from it at some point during their life. It usually presents as pain on the outside of the arm, but may also extend down the upper arm or commonly around the front of the shoulder towards the chest. It is also commonly associated with movement (particularly overhead) and possibly catching or clicking.

There are many different causes of shoulder pain due to the complex anatomy of the shoulder which is easily affected by other parts of the body (spinal posture, shoulder blade posture and the neck!). In the past it was thought that the sub-acromial bursa was the source of shoulder pain as it became ‘impinged’ between the two shoulder bones. However we now know that this is not always true as multiple studies have shown patients with no pain may still have a ‘swollen bursa’ on scans.

What we now know is that the source of pain is likely due to some irritation of the shoulder due to some impingement between the upper arm bone (humerus) and the tip of the shoulder (acromion). Another common source of pain may be the tendons of the shoulder (commonly supraspinatus). Scans will commonly report tears of the tendon but it is now thought that most tears aren’t an issue and just part of a normal degenerative process. However, the tendon can weaken and become painful due to repetitive micro-trauma, usually with overuse activities, a problem we term tendinopathy.

Treating shoulder pain is different for each individual. At Pro Physio SA our therapists aim at correcting the underlying cause of the shoulder pain which could be due to a number of factors (local stiffness, shoulder blade control, rotator cuff endurance amongst many others). Treatment may include soft tissue therapies to correct muscle impairments (massage or dry needling), shockwave therapy to promote tendon strengthening and specific exercises to correct the underlying causes. If you’re suffering from shoulder pain be sure to book in with one of our physiotherapists for a full assessment of your condition and advice to get you back on track.

Sam Townsley, Physiotherapist

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