Impingement

[Nicholas Wyss]

Hey all,

I wanted to get your thoughts on diagnosing and treating what I think is impingement. Although I have done a lot of weight training in the past, for the past 8 or so months my workouts have been almost exclusively in a gymnastics facility. I tumble, work on rings, P-bars, etc. A couple times while I was doing a press to handstand leaning against a wall I felt a little twinge in my shoulders, but usually after about a minute it would just go away.

It just so happened that my forearms splints were acting up, so I decided to take some time off doing things like planche training, p-bars, press to handstands, handsprings. I continued to do rings. Anyway, for some reason I thought, "Hey, since I am not doing any pressing at gymnastics I should go lift weights!"

So I am doing dumbbell bench press, feeling pretty strong, working my way up. I get to the 95 lb. dumbbells and do a set of 5, and it was almost like I could feel my anterior delts or something near them just get ratcheted down and not let go. I felt it in both shoulders simultaneously, but the right one was worse.

Now, 2 weeks later, the right shoulder still hurts, although it seems a little better. I can especially feel the pain when I lift it up overhead, and it feels like there is like something caught up in the groove where my arm would normally go. So I figure it must be impingement. I've just never had it last this long.

I probably shouldn't have done that much weight, I think my pecs are a lot weaker from when I used to lift weights more often, so the delts had to take over the movement and somehow cramped up or something. So I have been taking some time off, and doing self massage. I worked out using my arms for the first time 2 days ago and I was able to do pullups without any pain. I didn't try any pressing movements. I also did some external rotation with dumbbells.

So, does this seem like impingement? And, is there any specific exercise I should be doing to try to get the shoulder back into its proper groove? Should I do light internal rotation along with external? Or maybe that will just irritate it more?

Edit: I should add that when it first happened, the next day it hurt to even do a tiny amount of shoulder flexion when my arm was at my side, and it was really painful to palpate. Now the pain is just kind of a general annoying feeling of tightness, except when I move it in certain ways it hurts a little more. Palpation isn't nearly as painful but still slightly tender.

[Steven Low]

Where does it hurt SPECIFICALLY, with pictures?

Is it right under the acromion?

Where in each movement does it hurt

Which shoulder articulations hurt and don't hurt?


Impingement is one of those things like rotator cuff where people assume they have a problem. It's not necessarily that because the shoulder is complex so you either need to be more specific or see a professional

[Nicholas Wyss]

I'm not too good with posting pictures, but to palpate, I'm pretty sure it's either my anterior deltoid or corocobrachialis. The pain starts right under the corocoid process and then it runs down the front of my shoulder out towards my humerus. Somtimes it seems like it radiates out to the insertion of my deltoid. It also seems to radiate down my humerus sometimes towards my elbow, kind of along the long head of my biceps.

The movement that hurts the worst/most predictably is shoulder abduction, up at the top I can just feel the pain like right under the lip of my pec/anterior delt. It doesn't hurt in the beginning of the movement, just the top half I would say.

It also hurts to be pushed into external rotation when my humerus is adducted (at my side) while my elbow in in flexion. Or if I swing my arms back into the position at the bottom of a bench press. Finally, it hurts up at the top of shoulder flexion. Again, doesn't really hurt on the way up, just when I get to the top. When it's not moving it just kind of hurts a little bit all the time.

Edit: It may be obvious, but pressing hurts too, both horizontal and vertical.

[Nicholas Wyss]

So after trying to figure out which movements hurt and writing that whole description down, I think maybe it's not impingement after all, but maybe I just pulled either the anterior deltoid or the coracobrachialis. Does that seem right?

I went and got a massage today from an actual masseuse and it was brutal. There was some spots she would touch around the front of my shoulder that were really, really painful. It feels a little better now to move around, but when I touch where she was pushing on it, it feels tender in a different way, like more generalized and with less pressure required for me to notice the tenderness.

[Steven Low]

It could be impingement.

It seems more like tendonopathy or tensynovitis of some of the tendon structures there if it's more anterior. Impingement is usually more lateral.

Does ice or NSAIDs show any improvements at all?

If it's more of a strain then heat + mobility should help. If it tends to be more of impingement then NSAIDs and ice will tend to help more.

[Nicholas Wyss]

Thanks for the feedback Steven. The pain does seem more anterior. I will experiment with both treatments, see which provides more relief, and go from there.