Shoulder Impingement Syndrome

Shoulder Impingement Syndrome
Shoulder Impingement Syndrome
Impingement syndrome
Impingement syndrome is an irritation of the structures between the upper portion of your arm and your shoulder blade mainly during overhead arm movements.The rotator cuff is comprised of four muscles that help position the humerus, your upper arm bone, into the shoulder socket during arm movement.The shoulder has great mobility but at the same time is prone to injury during falls or accident, or when there is a lack of motor control (altered biomechanics).Men over 40 performing manual labour are the most affected with this condition. It is also present in young athletes practicing sports involving repeated overhead motion such as swimming, baseball or tennis.

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Structures involved

The tendons of the rotator cuff, ligaments of your shoulder and subacromial bursa are the most commonly affected structures. The subacromial space gets smaller during overhead movements. This can cause, over time, irritation, inflammation and/or a lesion of the rotator cuff tendons.

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Signs & Symptoms that you may experience

Everyone will react differently after an injury and recovery will depend on the severity of it.

Impingement syndrome can cause but is not limited to, pain at the front of the shoulder and localized swelling. Pain or tightness is often felt when you lift your arm overhead or when you lower it from an elevated position. Pain can also be felt around your shoulder blade in your back.

Other early symptoms can include light pain with activities or during rest and in some cases, irradiating pain around your shoulder. In severe cases, you might feel pain at night and a loss of strength or range of motion. Impingement syndrome can lead to rotator cuff tendinitis or shoulder bursitis when left untreated.

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Recovery

Your rehabilitation plan, health, fitness & nutritional status will affect recovery speed. Most of the time, you can expect to recover fully from impingement syndrome. As a rule of thumb, this condition can take up to three months to fully recover.

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▶ WHAT TO DO

Early Stage

Relative rest is a good way to protect your shoulder and prevent further damage, but it’s important to avoid overprotecting your injury. A few days rest where you avoid pain-inducing movement and activities might be necessary. A quick but progressive return to your activities of daily living, light cardiovascular exercise and specific range of motion and strengthening exercises will allow better recovery.

Rehabilitation

Follow your practitioner’s advice. It will help you manage the different phases of the recovery process and will increase the likelihood of successful rehabilitation. Your practitioner will assist you during your rehabilitation program in order to regain your normal range of motion, strength and endurance, optimal motor control and functional status.

As per the principles of rehabilitation for impingement syndrome, movement training through therapeutic exercises is an important part of functional recovery. A progressive exercise program performed over a few weeks period is pretty standard.

▶ WHAT TO AVOID

Don’t rely on passive treatment only. Each phase of the rehabilitation process is important. Patients that are actively involved in their treatment plan tend to recover faster. Keep in mind that pain is not always a good indicator of tissue damage. As soon as you feel better and the pain is well managed in collaboration with your therapist, you should reintroduce light strengthening exercises as tolerated.

Pain from trigger points in the supraspinatus muscle.

The supraspinatus muscle makes up part of the rotator cuff. It is responsible for assisting in shoulder abduction as well lateral rotation and stabilizing the shoulder joint. This muscle is often overloaded in labourers and tradesman who have to do a lot of overhead work. Athletes who do a lot of throwing movements will also frequently have Tigger point in this muscle. These trigger points will cause pain to be felt into the shoulder and down the arm, as well as stiffness and weakness.

Trigger point pain and the Teres Major muscle.

The Teres major muscle is located at the back of the armpit. It originates on the posterior aspect of the inferior angle of the scapula, and inserts and inserts on the medial lip of the intertubercular sulcus of the humerus. It’s main function is to assist adduction, internal rotation, and extension of the arm. This muscle only becomes active when there is resistance added to these movements. Trigger point pain from this muscle will cause pain to be felt deep into the posterior shoulder and down the back of the arm.

Pain from subclavius trigger points

The Subclavius muscle is a small muscle on the underside of the clavicle. It originates on the first rib and it’s cartilage, and inserts on the inferior clavicle. It’s main function is to assist in protraction of the shoulder. This muscle is often shortened and tight from poor rounded shoulder posture. When trigger points form in this muscle they can refer pain into the anterior shoulder and down the radial part of the arm. Pain can also be referred into the thumb and first two fingers.

Trigger point pain from the sternalis muscle

The sternalis muscle is a little known muscle located at the sternum. This muscle seems to be vestigial in that it doesn’t have a known function. In originates on the superior portion of the sternum and the upper part of the pectoralis muscle. It’s insertion is the cartilage of ribs 3-7, or sometimes the sheath of the rectus abdominis, or the lower part of pectoralis major. Even though this muscle doesn’t seem to have a purpose anymore it can still harbour trigger points. These points will cause pain to be felt intensely deep in the sternum, with spillover pain radiating down the inside of the arm.

Supraspinatus trigger points

The supraspinatus muscle is one of the muscles that makes up your rotator cuff. It attaches from the scapula to the humerus. It functions mainly to laterally rotate the arm as well as stabilize the shoulder joint. It also assists in abduction of the arm. This muscle can often harbour stubborn trigger points. These points refer pain into the shoulder, down the arm, into the elbow, and even into the forearm if irritated enough. These points can be effectively treated with trigger point massage therapy.

Tricep trigger points and elbow pain.

The triceps muscle is the main extensor of the elbow. It is the muscle in the back part of the arm and travels from the shoulder to the elbow. Trigger points in this muscle will cause pain when trying to straighten the elbow. Tricep trigger points refer pain into both the inside and outside of the elbow and are thus a common cause of both tennis and golfers elbow.