Treating Shoulder Joint Instability & Impingement – Glastonbury, CT

Causes of Impingement

Overhead activity of the shoulder, especially repeated activity, is a risk factor for shoulder impingement syndrome. Examples include painting, lifting, swimming, tennis, and other overhead sports. Other risk factors include bone and joint abnormalities.

However, the biggest underlying cause of impingement is undiagnosed instability of the shoulder joint! If the joint is unstable it allows the ball of the shoulder to shift upwards in the socket pinching the tendons and bursa. Instability is due to Rotator Cuff muscle weakness and stretching of the ligaments that support the joint.

Symptoms of Impingement

With impingement syndrome, pain is persistent and affects everyday activities. Motions such as reaching up behind the back or reaching up overhead to put on a coat or blouse or reaching to grab the seat belt in the car, for example, may cause pain. Pain most often is felt at or around the point of the shoulder and/or the upper part of the side of the shoulder and upper arm. There can also be shoulder weakness, though the weakness is really due to the pain inhibiting the muscle rather than the muscle itself actually being weak.

Over time, impingement syndrome can lead to irritation and inflammation of the rotator cuff tendons (tendinitis) and bursa (bursitis). If not treated appropriately, the rotator cuff tendons can start to thin out and tear, and the walls of the bursa can become thickened. In rare cases, the long head of the bicep’s tendon can rupture.

Symptoms of Instability

Shoulder instability is perceived as a sense of looseness in the shoulder joint. Some people also report a feeling of the shoulder “clunking” or slipping out of joint during certain movements. In extreme cases, the ball actually pops right out of the socket (dislocates).

Diagnosing Impingement Syndrome & Instability

The history and physical exam point to a suspicion of impingement and instability. Dynamic diagnostic ultrasound can be very helpful because we (the physicians) can actually watch the movement of the shoulder in real time and see if any impingement occurs. Ultrasound—but not x-rays—can also identify fluid in the bursa or thickened bursal walls (bursitis) and damage to the rotator cuff tendons. X-rays are not particularly helpful to diagnose impingement or instability, but they can help to rule out any arthritis. Bone spurs or changes in the normal contour of the bone may be present on X-ray. MRI is rarely needed for diagnosis, but it can help to rule out other possible causes of your pain, such as cartilage tears.

Treatment for Impingement & Instability

In our opinion, impingement is the victim– instability is the culprit! Treating the impingement without identifying and treating any underlying instability will result in a poor outcome.

Conservative treatment focuses largely on physical therapy, both to help improve the instability and to address any functional or movement patterns that are contributing to the impingement. If shoulder pain gets in the way of you doing physical therapy a cortisone injection can help to reduce the inflammation and allow you to continue with therapy. However, a cortisone injection is not a cure or fix and should never be done as a stand-alone treatment.

When physical therapy fails to help more aggressive treatment may be needed. In this case, Regenerative Medicine treatments, such as Prolotherapy, PRP (platelet-rich plasma), and stem cells can work wonders. These treatments not only can help heal the damage to the tendons of the rotator cuff, but also, they can help tighten the loose ligaments and stabilize the joint to reduce or eliminate the instability. We’ve been doing these treatments longer than anyone in southern New England, and few practices have our level of skill and experience.*

Surgery is always a last resort to treat impingement and instability.

(*NOTE: All Regenerative Medicine treatments are performed by our affiliate, the New England Stem Cell Institute.)