Shoulder impingement syndrome

What is clinging syndrome?

This is when certain structures in the shoulder (a tendon or the subacromial bursa) are pinched or jammed during shoulder movements. These structures become irritated and painful. This pinching takes place in the area of the shoulder known as the subacromial space.

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What is the subacromial bursa?

A bursa is like a small fluid-filled sac found in many of the body's joints. It acts as a cushion in the joint, lubricating structures that are exposed to more friction. This bursa can become irritated when you have a hanging syndrome.

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What is a tendon?

A tendon is the structure that attaches the muscle to the bone. When a muscle contracts, the force is transmitted to the tendon, and the tendon stiffens to move the bones.

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What causes clinging syndrome?

Snagging occurs when the structures in the shoulder joint (tendons and bursa) don't have enough room to move freely during shoulder movements. There can therefore be various causes that lead to less space for structures such as :

• Poor coordination of shoulder and scapula muscles
• Thickening of the subacromial bursa
• Inflammation or swelling in the shoulder joint
• Shoulder instability

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What causes pain in shoulder hook syndrome?

Hooking can cause excessive stress on different parts of the shoulder, which could irritate one or more of the following structures:

• The joint capsule and ligaments
• Tendons of muscles such as the supraspinatus, petit rond, infraspinatus or subscapularis
• The median, ulnar or radial nerve

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The pain can therefore vary depending on the structure that is irritated.

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What are the symptoms of clinging syndrome?

The most common symptoms are:

• Shoulder pain that usually appears gradually over several weeks or months
• Pain is usually in front of the shoulder and may radiate to the side of the shoulder and arm
• Pain is often worse at night when sleeping on the painful shoulder
• Shoulder pain and stiffness when raising your arms overhead
• Shoulder weakness and pain when lifting loads in the air

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The following tasks are often painful:

• Washing, drying or combing hair
• Put hand behind back to fasten bra
• Store high items such as crockery in the upper cupboard
• Sports with arms in the air (tennis, volleyball, badminton)

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How is clinging syndrome diagnosed?

Diagnosis is possible based on the history of symptoms and a clinical examination.

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When should a physiotherapist be consulted for clinging syndrome?

You should consult a physiotherapist if you have symptoms as described above or if your doctor has already ruled out any other cause that may be responsible for your pain.

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You do not need to see a doctor before consulting a physiotherapist. If your condition requires you to see a doctor, your physiotherapist will be able to tell you.

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What physiotherapy treatments are available for clinging syndrome?

Your physiotherapist will perform an assessment to determine the cause of the snag by evaluating the following:

• Your joint mobility
• The gliding of your nerves
• The quality of your movements
• Your strength and stability

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Based on the assessment results, your physiotherapist will:

• Mobilize your shoulder to reduce pain and improve your range of motion.
• will provide specific exercises to increase shoulder mobility, reduce pain, and improve control of your movements and muscle strength.
• Teach you how to properly manage your daily activities and hobbies to optimize healing
• Give you advice for your posture and movements.

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What to do at home for clinging syndrome?

Temporarily stop doing movements that cause too much pain, and then gradually start doing them again.

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Here are some other tips to help you:

• Usually, shrugging the shoulder before raising the arm upwards helps to reduce pain in the movement.
• If you have pain at night or morning stiffness, make sure your neck is well supported while sleeping with a pillow that fills the hollow of your neck.
• Avoid sleeping with your arm behind your head or under the pillow. Keep your arm along your body or supported with a pillow.
• Avoid sleeping on the painful shoulder.
• If you can't find a comfortable position for the night, use one or two pillows to support your arm.

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If you don't see any improvement after 10 days, you should consult a physiotherapist.

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Sources

Umer M, Qadir I, Azam M. Subacromial impingement syndrome. Orthopedic reviews. 2012 May 9;4(2).

Garving C, Jakob S, Bauer I, Nadjar R, Brunner UH. Impingement syndrome of the shoulder. Deutsches Ärzteblatt International. 2017 Nov;114(45):765.

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