Shoulder Impingement Syndrome

Patient often complains about their shoulder pain and the shoulder impingement syndrome is a common cause of it. Your shoulder is made up of several joints; combined with tendons and muscles that allow a great range of motion in your arm. Because of the structure, it is vulnerable to many different problems.

What is Shoulder impingement syndrome?

Shoulder impingement syndrome is a syndrome involving tendinitis of the rotator cuff muscles as they pass through the sub acromial space. There are different types of shoulder impingement syndrome. Among them four (4) main types of shoulder impingement syndrome are given below:

• Primary impingement.
• Secondary impingement.
• Sub coracoid impingement/stenosis.
• Posterior Superior Glenoid impingement.

Causes of shoulder impingement syndrome:

• Overuse: Overhead activities of shoulder such as painting, lifting heavy weights, swimming, playing tennis and also other overhead players have an increased risk to develop impingement.
• Curved or hooked acromion: Some people have curved or hooked acromion naturally. People who have curved or hooked acromion bones typically have a smaller sub acromial space than a person who has a flat acromion. For this reason the people having curved or hooked acromion are in high risk for shoulder impingement syndrome.
• Poor posture: Posture while reading or sitting at a desk for a long period of time, also activities like driving or cooking can play a role in the development of shoulder impingement.
• Bone spur: Bone spurs are the projection that can cause sub acromial space to narrow and become smaller. As a result shoulder impingement may develop.
• Shoulder instability: Shoulder instability refers to when shoulder muscles, tendons and ligaments no longer secure the shoulder joint and causing pain. That’s the reason the shoulder is prone to shoulder impingement syndrome.
• Previous shoulder injuries: People who have sustained injuries to the shoulder joint are at high risk for shoulder impingement in future.
• Age: Shoulder impingement is most often seen in active adults, especially as they get older; although it can develop at any age.

Symptoms for shoulder impingement syndrome:

• Difficulty in reaching up behind the back.
• Pain when the arms are extended above the head.
• Weakness in shoulder.

Investigation:

• X-ray: To rule out arthritis.
• MRI: It is used to identify bone spurs.
• Musculoskeletal ultrasound: To check out ligament, muscles and tendons tear.

Clinical examination:

• Hawkins test: In Hawkins test the examiner elevates the arm to 90 degrees of abduction and forces the shoulder into internal rotation, impinging the cuff under the sub acromial arch is the positive sign for the test.
• Neer test: The neer test can be performed in the sagittal plane. The examiner stabilizes the scapula while passively elevating the shoulder, in effect impinging the humeral head into the acromion process is the positive sign for the test.
• Empty can test: Durring Empty can Test patient should be seated on a chair. Arms are abducted to 90o, internally rotated, thumbs are pointed down and also arms are moved about 30o forward. Examiner then applies resistance to abduction. Weakness or pain is positive sign.

Treatment

Acute phase: In an acute condition patient needs to take rest and icing the area 10-15 minutes for two times a daily.

Chronic phase: In most cases it will take three to six months to heal but if the case is in chronic condition than it can take up to a year to heal.

In chronic condition patient must concern with a physiotherapist for better solution. A physiotherapist will apply two types of treatments.

Manual: 

1: Activity modification: A physiotherapist will find out the improper techniques for which he/she suffers with the disease.  Also the physiotherapist will correct his/her functional techniques.

2: Range of motion improving exercises: After checking ROM of the affected region physiotherapist will improve the condition of restricted motion. In this stage physiotherapist can apply mulligan concept.

3: Stretching exercises: 

• Adviced patient to bring the affected arm across the chest and place it in the crease of sound elbow or use sound hand to support that affected arm.
• Patient should be in standing position. Hold an exercise band, strap or towel behind his/her back with both hands. Broaden across chest as move shoulder blades towards each other. Lift chin and look up toward the ceiling. Patient should hold it for up to 30 seconds and repeat 3-5 times a day.
• Patient should stand in a doorway with elbows and arms, forming a 90 degree angle. Step one foot forward and make a rotation as patient presses his /her palms into the sides of the door frame. Hold position for up to 30 seconds.

4: Strengthening exercises: In the rehabilitation stage a physiotherapist will adviced for some strengthening exercises to the patient. Such as:

• Pendulum
• Finger walk
• Outward rotation
• Inward rotation

Electrical: 

1. UST- It is a sound wave which passes through in deep tissues and also makes a resonance that increase blood circulation and release pain.
2. TENS- Electromagnetic wave that helps to reduce pain.
3. HIL- Helps in deep penetration and reduce pain.
4. ESWT- In case of chronic condition ESWT helps to create micro trauma and also helps in automatic healing.