Shoulder Pain, Injury & Dysfunction : Impingement Syndrome

Shoulder pain is a widespread problem second only to lower back pain.

According to research, shoulder impingement is the most common condition for persistent shoulder pain. Shoulder Impingement Syndrome is a progressive condition involving a combination of factors and symptoms.

What is Impingement? In a shoulder movement, the rotator cuff helps control the head of the humerus by keeping it in contact with the glenoid cavity (socket of the shoulder joint). The rotator cuff muscle and tendon (supraspinatus) tissues at the top of the arm pass through the subacromial space and attach to the shoulder blade (scapula). Rotator cuff supraspinatus tissues are susceptible to weakness, strain and damage for a variety of reasons including; abnormal positioning of the shoulder blade, by over-doing repetitive movements,due to injury and from wear and tear. Inflammation and swelling of the tendon and bursa cause these become pinched within the narrowed subacromial space. This is known as ‘impingement’.

What are the signs of Impingement? Pain is noted when the subacromial space is at its most narrowed when performing an ‘arc’ movement of the arm. This is when the arm is raised straight to the side and held in a horizontal position.

Pain is often described as occurring with twisting movements such as putting jackets on etc., pain at night when the arm is resting, a locking sensation in the arm with certain positions.

Why is Pain Management important? A focus on reducing pain is vital for a successful treatment programme in order to allow the rotator cuff muscles to engage in normal function. During the acute phase of impingement, a reduction of pain and inflammation can be achieved through use of therapeutic applications such as ice packs. Cryotherapy (cold/ice therapy packs) serves as a vasoconstrictor to reduce the metabolic activity and reduce inflammation in addition to increasing pain threshold. After the acute phase, Thermotherapy (warm/hot therapy packs) is applied to warm and prepare the capsule and musculotendinous tissue for mobilisation. Active-assisted range of motion, stretching exercises and, manipulation of the soft tissue increases circulation and promotes healing.

(Therapy Packs can be purchased from my website to assist with this type of pain management)

How is Impingement and dysfunction treated? Impingement is usually treated conservatively with rehabilitation therapy to assist the body to heal itself.

Following a thorough evaluation to identify the causative factors and determine the structure/s involved, a treatment programme will aim to:

• reduce stress within the shoulder structures

• break the pain and inflammation cycle

• suggest sufficient rest from overhead sport or activities

• inform on postural awareness in sitting/standing positions to increase subacromial space.

• advise modification of or alternative ways to do daily activities

• inform the importance of strengthening exercises

• agree a specific rehabilitation treatment programme

What can be expected from Impingement Rehabilitation Treatment?

A programme of treatment needs to be tailored to the individual's complaint.

Rehabilitation for shoulder pain and impingement syndrome is a multi-focused programme of rest, rotator cuff and scapula strengthening exercises and, manual techniques involving massage, stretching and manipulation aiming to reduce pain and reduce the effect of impingement, restore strength and stability, regain range of movement, re-establish dynamic rotator cuff stability, and restore muscular endurance in the rotator cuff and scapula.

Studies indicate improvements can be made after 3 weeks of undertaking rehabilitation treatment with data reporting less pain, improved function and strength.

In Summary: It is imperative that for an effective rehabilitation programme, the Therapist Practitioner needs to have a clear understanding of the importance of reducing pain; be focused on re-establishing dynamic rotator cuff stability; aim to restore strength and muscle endurance in the rotator cuff and scapula; and recognise the significance of regular targeted therapy to swiftly attain full range of movement.

I hope that you have found my article informative and you understand a little more about shoulder issues. This article should not be a substitute for seeking professional medical examination and advice. It is supplementary to an assessment and treatment by a registered and qualified Therapist Practitioner.

Sources:

Neer CS., 2nd Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am. 1972;54(1):41–50. [PubMed]

Michener LA, Walsworth MK, Burnet EN. Effectiveness of rehabilitation for patients with subacromial impingement syndrome: a systematic review. J Hand Ther 2004; 17:152.

Jobe FW, Pink M. Classification and treatment of shoulder dysfunction in the overhead athlete. J Orthop Sports Phys Ther 1993; 18:427.

Hutton Ks, Julin MJ. Shoulder injuries. In: Team Physician's Handbook, 3rd, Mellion MB, Walsh WM, Madden C, et al (Eds), Hanley & Belfus, Philadelphia 2002. p.397.

Devereaux M, Velanoski KQ, Pennings A, Elmaraghy A. Short-Term Effectiveness of Precut Kinesiology Tape Versus an NSAID as Adjuvant Treatment to Exercise for Subacromial Impingement: A Randomized Controlled Trial. Clin J Sport Med 2016; 26:24.

www.ole.bris.ac.uk/bbcswebdav/institution/Faculty of Health Sciences/MB ChB Medicine/Year 3 MDEMO - Hippocrates/Hippocrates/shoulder pain etutorial/subacromial_space.html

Oxford Shoulder and Elbow Clinic Leaflet www.oxfordshoulderandelbowclinic.org.uk January 2004