Impingement of one or a number of structures in the area of the shoulder is the principal reason that this occurs. Most commonly involved are the biceps tendon, a rotator cuff muscle (usually the supraspinatus) or a bursa.

But what causes this impingement?  There are a number of reasons why this impingement occurs, while there are also some predisposing factors why some people maybe more apt to develop this problem than others.

Perhaps the most common reason for an impingement to develop is capsular tightness, which can often develop over time, secondary to limited use of the arms overhead. When the capsule becomes tight, the humeral head fails to move in a downward or backward position as the arm is raised overhead, which results in one of more tissues becoming impinged. In turn, as the individual strives to lift their arm overhead, they commonly succeed in irritating these structures which causes tendinitis and/or bursitis to develop, making the problem worse.

This form of impingement can be further complicated by the presence of a bone spur, which has developed over time, due to the wear and tear on the joint over many years, while arthritic changes in the joint are also commonly present.

Another reason for impingement is instability of the joint or weakness of the rotator cuff tendons due to an injury or a tear. In the presence of instability or a rotator cuff injury, once again the humeral head fails to move as it should when raising the arm overhead and the impingement occurs.

Individuals most likely to develop this problem, include those individuals that work with their arms repetitively overhead (such as your HVAC technicians), athletes that use their arms overhead (tennis players, swimmers, pitchers etc.,) and also individuals with poor posture (rounded shoulders) . Poor posture will commonly result in diminishing what is referred to as the sub acromial space, which heightens the possibility for an impingement to occur.

So, what can you do about this problem?

To relieve the pain, avoiding using the arm overhead, taking an anti-inflammatory medication & icing will likely help, unless you have a rotator cuff tear, whereby the relief you note will likely be minimal. However, these measures fail to address the underlying reason for the problem.

The key to overcoming this problem in the majority of cases, will be to attend for a program of Physical Therapy. At the time of your initial appointment, the therapist will pinpoint the reason for the impingement and will then design a therapy program that will improve capsular mobility and joint stability, reduce the inflammation, improve your rotator cuff strength and improve your upper quadrant posture which collectively will address the problem and provide you with long term pain relief. Of note, when there is a rotator cuff tear, a labral tear or a large bone spur, the therapy may not be successful, but the therapist is typically able to recognize this early on in your treatment (if not the 1st session) and in these instances will typically recommend diagnostic testing or an orthopedic surgery consultation.

So, if you have this problem, recognize that it is unlikely to get better over time (in fact it may get worse) and ask your physician to refer you for Physical Therapy.