SHOULDER IMPINGEMENT SYNDROME
An ever-increasing number
of Americans are becoming more active in their quest for a healthier lifestyle.
Aerobic exercise classes, weight training, competitive sports activities, not
only results in increased strength and endurance, but, all too frequently,
injuries and overuse problems. Shoulder pain syndromes, commonly diagnosed as
impingement syndromes—tendon or nerve caught within the joint, are being seen in
greater numbers at our physical therapy practices.
The design of the shoulder joint for maximal mobility results in a
compromise in the degree of structural stability. Regardless of the cause of
shoulder dysfunction, if improperly or inadequately treated, the shoulder
quickly loses range of motion and is nearly impossible to regain without formal
physical therapy intervention.
Shoulder pain can result from internal disorders from poor
body mechanics. The obvious symptom of impingement is pain or dysfunction of the
rotator cuff--made up of four major muscles, S.I.T.S. (supraspinatus,
infraspinatus, teres minor, and subscapularis).
Physical findings for these syndromes include tenderness to
touch over the front of the shoulder joint at the muscle insertion point, a pain
through an arc of abduction between 70-120 degrees, or painful testing during
passive (with help) ranges.
These impingements usually begin as bicep or rotator cuff
tendonitis, which fall into various stages.
Stage one, edema and hemorrhaging at the insertion point of
the muscle occurs.
Stage two, the bursa is involved and there is a thickening
and fibrosing—scar tissue of the rotator cuff, leading to increased impinging of
the tendon. Pain is present during activity and increases afterward. Weakness
begins with simple activities such as lifting the arm.
Stage three there becomes a permanent thickening of the
rotator cuff and frequent spurring of the top and/or bottom of the shoulder
joint as well as a 1 cm tear of the tendon.
Stage four there is chronic pain and dysfunction of the arm
as well as continuing tearing of the rotator cuff. By this time surgery and post
operative physical therapy is a must to regain ones function.
Shoulder pain, which does not require surgery, can be
treated with conservative rehabilitation procedures as soon as diagnosed.
Specific protocols are followed and determined by the physician and/or physical
therapist. They include a variety of scapular stabilization exercises to
increase the integrity of the rotator cuff and biceps as well as treatments—ice,
electric stim, ultrasound, etc., to decrease edema, pain and muscle atrophy.
In order to avoid these problems always keep in mind that
while engaging in athletic activities one must note correct body mechanics and
proper form with movement at the shoulder joint. If you are uncertain, or if you
have an existing problem and it has been recurring see us at APTA. We are always
open for questions and answers to these types of pathologies.
Knowledge is prevention