Shoulder Impingement | Plenty Physiotherapy, Bundoora

Shoulder Impingement Document 

Shoulder impingement syndrome  is a painful condition of the upper extremity resulting from a  structural narrowing of the  subacromial space. This painful  shoulder condition happens when the rotator cuff tendons and/or  subacromial bursa are  compressed against the acromion,  coracoacromial ligament, or AC  ring arm elevation (where  these is already normal narrowing  of this space). This may involve the compression of supraspinatus  tendon and bursa in the region. ue to this pain and inflammation it may limit shoulder range of motion and cause  further injury to the tendons in the shoulder.  Pain commonly is in the anterior/lateral shoulder, often worse with overhead or reaching  activities, as seen in patients presenting with a painful arc (60°-120° shoulder  abduction). Night pain when lying on the affected shoulder can be a symptom.  Contributing Factors:  A) Anatomical factor: The shoulder can have anatomical variations, such as a  hooked acromion (a bone at the top of the shoulder blade), which may increase  the risk of impingement. The rotator cuM sits in a small space between your  humerus and the acromion (the upper part of your shoulder blade). This makes  your rotator cuM susceptible to being pinched between these bones. That  pinching is a shoulder impingement symptom. Additionally, bursitis is  inflammation of a bursa, a fluid-filled sac that lines some of your joints. A bursa  between your rotator cuM tendons and acromion normally cushion the space  between them. Swelling from bursitis can lead to shoulder impingement  symptoms. Therefore, poor posture for sustained periods can result in altered  shoulder mechanics and impingement. Contributing factors may include  scapular dyskinesis (poor upward rotation, winging), weak rotator cuM relative to  the deltoid muscle leading to humeral head migration and impingement, or  thoracic kyphosis/forward head posture. B) Acute Injury: Can be more likely to develop after a shoulder injury or trauma. C) Intrinsic tendon factors: a. Overuse or degeneration (age-related tendon changes) b. Poor vascular supply in supraspinatus tendon) Extrinsic/anatomical: a. Acromion shape (hooked acromion) b. Acromioclavicular joint osteophytes c. Subacromial spurs  Overused and repetitive movements: Completing repetitive overhead  activities, such as throwing, painting or weightlifting, can strain the shoulder  tissue and lead to impingement.  Treatment/Management: e and pain medication: Ice as well as using forms of pain killers/Anti inflammatories (as directed by your medical professionals) can help manage  acute bouts of pain.  2) Load management: Initially minimising/removing aggravating factors and  activities. These factors can be things such as minimising overhead lifting,  throwing movements, or repetitive motions. Load management is crucial,  therefore laying out your current exercise/sports schedule and modifying things  such as frequency, duration, and intensity will support your recovery and aid the  healing process.  3) Physiotherapy/rehab: Exercises targeting the muscle imbalances and poor  biomechanical patterns above and below the shoulder joint will aid in proper  shoulder movements and optimal loading. Specifically, focusing on a gradual  range of motion program with a tolerated progressive strengthening of the rotator  cuM, deltoid, and scapular stabilisers is of importance. Over time, building this  strength training into more power and plyometric shoulder exercises with  specific return to sport movements. Manual therapy such as soft tissue work can be utilised to help with pain  reduction and shoulder mobility and stiffness. 4) Surgical/Medical intervention: The use of X-ray and Ultrasound scans will  generally be able to confirm diagnosis of shoulder impingement and assess the  rotator cuM tendons. MRI might be indicated pending symptoms and progress. In  some presentations, if conservative management is not responding as expected  or the presentation is severe as per the imaging results, it may warrant cortisone  injection of the bursa or referral to a specialist. It is important to note that  conservative management will help many individuals to improve their symptoms  and return to their daily tasks and leisure.