Shoulder impingement is one of many possible causes of shoulder pain.
Or is it?
Shoulder impingement, so the story goes, is caused by a narrowing of the subacromial space when the arm is abducted or lift your arm away from your body sideways.
This action raises the greater tubercle of the humerus and closes in on the subacromial space which, in theory, compresses the supraspinatus tendon causing pain and irritation.
I argue that the impingement has its roots in damaged ligaments and tendons. There are several of these structures in the area that could make it seem like impingement was the issue. Maybe it is impingement but WHY is it getting impinged. Because of weakened and/or damaged tendons and ligaments.
How do you diagnose shoulder impingement?
Shoulder impingement is typically diagnosed by the history and physical exam. It is a clinical diagnosis. 2 common tests used to evaluate for impingement are Hawkin’s and Neer’s signs. If symptoms are reproduced with these tests then it is suggestive of rotator cuff disease. MRI may or may not be helpful and I rarely order them for this type of shoulder pain.
How do you treat shoulder impingement?
Shoulder impingement is often treated initially with conservative therapy which consists of rest, physical therapy, taping, acupuncture, and avoiding doing anything that causes pain. If that doesn’t work then anti-inflammatory medications (NSAIDs) are often given and the patient may get a steroid shot. Sometimes the steroid shots work but they often don’t.
I vividly remember being taught how to do a steroid injection for shoulder pain when I was in residency. I was taught a single technique in a single location for the shoulder. That may work well when the painful or damaged area is the area I happen to inject the steroids. But it often isn’t.
Why did I learn a single injection and assume that it would fix all potential issues that a shoulder may help with? That makes absolutely no sense. I clearly wasn’t thinking!
If these techniques don’t work then surgery may be recommended.
Prolotherapy for shoulder impingement?
I strongly recommend prolotherapy for potential shoulder impingement issues. In fact, I can’t think of a shoulder that we didn’t help for shoulder impingement. It is just that good.
Prolotherapy stimulates your body to heal itself through its own natural inflammatory process. It can strengthen the weakened and damaged ligaments and tendons that are causing the problem to begin with. When these tissues are healed through the body’s normal healing processes then the pain goes away and full function is restored.
We treat a LOT of shoulders with prolotherapy. We’ve had good enough success with prolotherapy for shoulder pain, SLAP lesions, rotator cuff tears, and shoulder impingement that I just won’t recommend surgery until after the patient has failed prolotherapy. It is rare but it can happen.
Plus, remember that prolotherapy has very little risk. In fact, C. Everett Koop, MD, the former Surgeon General of the United States, stated “the nice thing about prolotherapy, if done correctly, is that it cannot do any harm.”
There is very little risk, basically no downtime, very cost effective. Why don’t you call us to be evaluated for prolotherapy for your pain?
