Mississauga Chiropractor Presents: Shoulder Impingement

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Here’s another blog from a Mississauga Chiropractor…

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A shoulder impingement is repeated irritation or pinching of the biceps brachii or rotator cuff tendons as they pass between the coracoacromial arch & the greater tuberosity of the humerus.

 

Three Progressive Stages:

 

Stage

Clinical   Description

1

Edema & hemorrhage resulting from excessive overhead   activities; typical age is less than 25 years old.  This can be treated effectively with   conservative treatment.

2

Fibrosis & tendinopathy resulting from repeated   episodes of mechanically induced inflammation; typical age is between 25-40   years old.  Conservative treatment can   contain but not reverse the damage.    The shoulder will function satisfactorily during light activity but   becomes symptomatic after vigorous overhead use, excessive repetitive use or   heavy lifting.

3

Trophic changes in the rotator cuff, biceps & adjacent   bone leading to tendon ruptures & alterations of the acromion &   greater tuberosity;  progressive   disability often leads to surgical intervention; typical age is usually >   40 years old

 

Mechanisms:

a)      Anterosuperior:

  1. Forward elevation (flexion) & abduction during throwing activities (e.g. baseball & football), the overhead stroke in tennis, swimming, water polo & weight lifting.
  2. The long biceps, infraspinatus & supraspinatus tendons are thrusted against the anterior edge of the acromion & coracoacromial ligament.
  3. Repeated impingement results in chronic inflammation
  4. The more often this occurs, the greater risk of further impingement

 

b)      Internal:

  1. Repeated overhead abduction-external rotation pinches supraspinatus against the posterior-superior glenoid rim & labrum
  2. This will lead to degenerative changes and posterior shoulder pain

 

Risk Increases with:

a)      Heavy overhead activities – athletes, welders, painters; leads to acute rotator cuff strain

b)      Weakness or atrophy of rotator cuff; muscle imbalances within the shoulder girdle

c)      Osteoarthrosis of the AC joint

d)      Protracted shoulder posture due to issues with the internal rotators of the shoulder

e)      Weakness in the lower trapezius muscle, serratus anterior muscle and levator scapula muscle

 

History:

a)      Often several previous episodes; May complain of recurring or constant toothache like pain that is worse at night; can be aggravated with a firm mattress.

 

b)      Involvement in repetitive overhead activities, sports or work (e.g. welding or sleeping with arm abducted.)

 

c)      Painful during shoulder flexion & abduction (between 70-120 degrees); patient may have full range of motion in abduction & flexion but a painful “catch” impingement sign at 180 degrees.

 

Management:

Acute: (first 2-7 days)

a)      Treatment frequency: 3X/wk to reduce pain & swelling – ice & rest

b)      Electrotherapy (IFC or microcurrent)

c)      Ice every hour on first day for 15-20 minutes each time; then 5 times/day for 5 more days

d)      Scapular mobilization

e)      Avoid overhead or painful activities

f)        Pendulum exercises

 

Subacute: (2-4 weeks)

a)      Treatment frequency: 1-2xéwk; frequency is tapered with improvement

b)      Humerus, scapula & clavicle mobilization

c)      Electrotherpy (IFC or microcurrent alternating with ultrasound)

d)      Begin exercises every other day & follow with ice

  1. 1 minute hang – 5lbs (arms at side) to distract the shoulder downwards
  2. Codman`s Pendulum with 5 lbs
  3. Corner stretches; avoid shoulder shrugs at this time because it increases impingement
  4. Avoid repeated overhead activities & change sleeping positions as needed

e)      Massage therapy:  entire shoulder region with myofacial release, active release technique (ART) and trigger point therapy.

f)        PNF stretching:  internal & external rotation; extension/flexion; abduction/adduction

 

Recovery:

a)      Treatment frequency:  1x/week – mobilize the shoulder & back with electrotherapy

b)      4-8 weeks of vigorous stretching/strengthening at home; focus is to:

  1. strengthen of the rotator cuff and increase flexibility of the shoulder girdle muscles
  2. strengthen the shoulder girdle retractors & stretch the shoulder girdle protractors
  3. strengthen the serratus muscles

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