What is Posterior / Superior Shoulder Impingement?
66% of all shoulder injuries are impingement injuries. Impingement is diagnosed as either primary, secondary, or posterior (internal). An impingement means that the soft tissue of your shoulder gets “pinched” where your collar bone (clavicle) and head of your shoulder bone meet. This causes you to have pain when raising your arm overhead or out to the side. This can occur either through wear and tear of the shoulder (primary impingement), muscle weakness or imbalance (secondary impingement), or because of tightness in the capsule that surrounds your shoulder joint (posterior). A posterior impingement is typically seen in throwing athletes, volleyball and tennis players, and occupations with repetitive overhead activity.
There are many tests for diagnosing shoulder impingement. Your doctor or physical therapist can evaluate the joint mobility of your shoulder to assess how tight the capsule is and determine the next course of treatment. When the back part of your shoulder becomes bound down it causes the shoulder joint to ride forward and up in the socket. Treatment for a posterior impingement includes stretching the muscles of your chest and neck and strengthening the muscles of the shoulder blade to bring the shoulder down and back. Treatment will also include manual stretching by your physical therapist to loosen the capsule and allow the shoulder to sit in the socket at a better position to allow more freedom for overhead motion.
Treatment will typically last from 4-6 weeks to allow for retraining of your muscles and loosening of the capsule to occur. You will be seen for physical therapy three times a week and also prescribed a daily home exercise program. Initial soreness may be experienced, but you should let your physical therapist know if pain is increasing or if any of the exercises you are performing hurt. If conservative treatment fails, a surgeon may go in to release the capsule to allow the shoulder to slide back and down into the joint space. After the surgery, you can expect to be in physical therapy for pain relief and muscle re-education.
Most people experience relief of symptoms and are able to return to their daily activities. Although shoulder impingement is common, it is very treatable while working closely with your healthcare professional team. Your doctor or physical therapist will be able to answer any additional questions you may have regarding your shoulder pain.
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