Shoulder pain can make simple chores almost impossible. Have you ever reached for an object high on a shelf only to have pain that takes your breath away? What causes shoulder pain when reaching across the body? What is shoulder impingement? What does shoulder impingement feel like? Can a shoulder X-ray show shoulder impingement? What are the treatment options for shoulder pain when reaching across the body? Let’s dig in.
Why Does My Shoulder Hurt When I Reach Across My Body?
Shoulder impingement and rotator cuff injuries are among the most common causes of shoulder pain (1). Both can cause shoulder pain when reaching across the body.
Shoulder impingement is a painful condition in which the bursa and muscles of the shoulder are pinched or compressed. This occurs in any area called the subacromial space which is immediately beneath the AC joint. This area contains the rotator cuff tendons and bursae and is identified by the red in the illustration below (2). A bursa is a fluid-filled sac that reduces the friction on tendons and muscles as they cross boney surfaces. A tendon is a thick collagen tissue that connects muscles to bones. The rotator cuff tendons provide important support and enable movement in the shoulder.
Rotator Cuff Injuries
There are four rotator cuff tendons: supraspinatus, infraspinatus, subscapularis, and teres minor. Injuries can include inflammation of the tendon called tendonitis and tears in the tendon. Tears can be partial thickness where they only involve a portion of the tendon or full-thickness when they involve the entire tendon. If the tendon fibers pull apart from one another this is called a retraction. Rotator cuff tears are common and the incidence increases with age. A recent large study demonstrated a prevalence of rotator cuff abnormalities of 9.7% in patients younger than 20 which increased to 62% in patients aged 80 and older (3). Factors that increase your risk for RC tears include advancing age, hand dominance (4), and smoking (5). Learn more about our non-surgical rotator cuff tear treatment.
A Deeper Dive
AC Joint Impingement
AC joint Impingement is a painful condition that occurs when the space beneath the acromion bone is narrowed. This narrowing can result in irritation of the rotator cuff tendons and bursa. A bursa is a fluid-filled sac that reduces the friction on tendons and muscles as they cross bony surfaces. A tendon is thick collagen tissue that connects muscles to bones. The rotator cuff tendons provide important support and enable movement in the shoulder. If severe, impingement can cause tears in the rotator cuff tendons. Patients with AC joint impingement typically have pain with elevation of the arm and or while lying on the shoulder.
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Arthritis in Shoulder
The shoulder is a truly remarkable joint. It allows you to reach out into virtually all directions: overhead, forward, and backwards. Unfortunately, like other joints in the body the shoulder is susceptible to irritation and injury.
Osteoarthritis is the most common cause of disability in the United States, affecting up to 32.8% of patients over sixty years of age (1). Shoulder arthritis is a common condition estimated to be as high as 16-20% in the middle aged and elderly population (2). Shoulder arthritis can compromise range of motion, strength and be a source of debilitating pain. This blog will review the shoulder.
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Avascular Necrosis of the Shoulder
Avascular Necrosis is essentially a lack of blood flow, eventually resulting in necrosis, or dying of the bone. This happens in multiple joints. And today we are talking specifically about the shoulder. So talking about AVN in the shoulder, patients typically come up with two main questions. Number one, can this heal on its own? And if not, how long or how fast will this progress? Now we classify AVN in multiple different stages: Number one: we have stage one, where it is very normal X-ray — usually, typically, someone just has pain with activity. Is the bone itself continues to deteriorate, then we start getting some changes on your X-ray.
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Ehlers-Danlos Syndrome (EDS)
Disorders that affect and weaken the connective tissues such as tendons and ligaments. It is a hereditary disorder which means you are born with it. EDS has many different signs and symptoms which can vary significantly depending upon the type of EDS and its severity. It most commonly affects the skin, joints, and blood vessels. Joints are typically hypermobile with excessive joint range of motion because of a defect in collagen formation. In most cases Ehlers-Danlos syndrome is inherited. That is to say that you are born with it. The two main ways EDS is inherited are: autosomal dominant inheritance and autosomal recessive inheritance…
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Frozen shoulder, also known as adhesive capsulitis, is a painful loss of shoulder movement and range in motion. The incidence of frozen shoulder is 3-5% in the general population and up to 20% in those with diabetes. The peak incidence is between 40-60 years of age. The exact mechanism is poorly understood. In general, the capsule becomes inflamed, thickened, and contracted with pain and significant restriction in range of motion. causes are poorly understood but risk factors include trauma, prolonged immobility, systematic diseases such as diabetes, stroke, connective tissue disease, and heart disease. Other causes include post-surgery, chronic inflammation causing stimulation of myofibroblasts
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Rotator Cuff Tear
Are you plagued by shoulder pain that has now transitioned from intermittent to constant and keeps you up at night? Are daily shoulder movements, such as dressing and reaching for objects in the kitchen cabinets, painful? Is your range of motion decreasing as your pain is increasing? You may have a full- or partial-thickness rotator cuff tear. Has conservative therapy in the form of heat, ice, stretching, rest, and acupuncture failed to provide significant relief? Has an MRI demonstrated a full-thickness or partial-thickness tear of the rotator cuff? What to do? If left untreated, full-thickness and 26% of partial-thickness tears will progress.
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Shoulder Impingement Syndrome
Pain is the most common symptom. It typically occurs with the elevation of the arm, forced movement overhead, and when lying on the shoulder. Impingement can also cause shoulder pain when reaching across the body. Narrowing of the subacromial space is the most common cause of shoulder impingement syndrome (6). The subacromial space is the area between the top of the arm bone (humerus) and the AC joint. This narrowing compresses or pinches the rotator cuff tendons and bursa. If left untreated the rotator cuff tendons can become inflamed, damaged, and or torn.Bursa and tendons can not be seen on x-ray. An x-ray may demonstrate…
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Shoulder Labral Tears
The labrum is a cartilaginous cup that circles the shallow shoulder socket (the glenoid) to make the socket deeper. The labrum supports and stabilizes the shoulder joint. Causes of Shoulder Labral Tears
Injury to the labrum typically occurs from repetitive trauma in overhead throwers, such as in baseball. It can also occur from a traction injury to the arm, such as lifting a heavy object off the ground or getting your arm jerked. Symptoms of Shoulder Labral Tears. Typical symptoms include pain in the front of the shoulder or deep inside the joint. Treatment options initially include physical therapy which is designed to restore range of motion and strength to the shoulder.
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Thoracic Outlet Syndrome
The thoracic outlet is an area around the collar bone where the nerves that come from your neck meet up with the blood vessels from your heart and together supply the entire upper extremity (shoulder and arm). These blood vessels (subclavian artery and vein) and nerves (brachial plexus) travel from the base of your neck to your armpit (axilla) and are considered the “thoracic outlet”. Now that you know what the thoracic outlet is, what is thoracic outlet syndrome? Simply listening to a patient’s history and completing a physical examination is all that is needed to diagnose TOS. But more involved imaging such as X-rays…
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The temporomandibular joint (TMJ) is the joint connection between your jaw and your skull. If you run your fingers along either side of your jaw line toward your ears, you can actually feel where the jaw bone ends and the skull bone begins. If you open and close your mouth, the difference between the two is dramatic as the jaw bone moves, thanks to the TMJ joint, while the skull bone remains stable. The TMJ and any of its surrounding structures can become painful and inflamed, and this can become so bad that it can prevent patients from even being able to move their jaw bone to chew.
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Shoulder impingement and rotator cuff injuries are among the most common causes of shoulder pain when reaching across the body. Shoulder impingement is a painful condition in which the bursa and muscles of the shoulder are pinched or compressed. This is typically caused by the narrowing of the subacromial space in which shoulder pain when reaching across the body is common. An X-ray may suggest shoulder impingement but MRI is a better imaging choice. Treatment includes conservative care. Steroids should be avoided. Subacromial decompression is a common surgery that is no better than a placebo. PRP and bone marrow concentrate injections are effective, nonsurgical treatment options for shoulder impingement.
1.Cohen RB, Williams GR: Impingement syndrome and rotator cuff disease as repetitive motion disorders. Clin Orthop 351: 95-101, 1998
2.Ludewig PM, Braman JP. Shoulder impingement: biomechanical considerations in rehabilitation. Man Ther. 2011;16(1):33-9. doi: 10.1016/j.math.2010.08.004
3..Teunis T, Lubberts B, Reilly BT, Ring D. A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. J Shoulder Elbow Surg. 2014;23:1913–1921.DOI: 10.1016/j.jse.2014.08.001.
4.Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, Kobayashi T. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg. 2010;19:116–120.
5.Baumgarten KM, Gerlach D, Galatz LM, Teefey SA, Middleton WD, Ditsios K, Yamaguchi K. Cigarette smoking increases the risk for rotator cuff tears. Clin Orthop Relat Res. 2010;468:1534–1541. DOI: 10.1007/s11999-009-0781-2