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.

Shoulder Labrum Tear

Shoulder Labrum Tear

Shoulder labrum tear

A labral tear represents a tear of the labrum, which is a piece of fibrocartilage (rubbery soft tissue) attached to the rim of the shoulder socket that helps keep the ball of the joint in place.

The shoulder is the most mobile joint in the human body, but this great mobility comes at the expense of stability and increased injury risk.

A labral tear may occur slowly over time or suddenly as the result of accidents such as a motor vehicle accident, a fall on an outstretched arm or a shoulder dislocation. People who participate in repetitive overhead sports, such as throwing athletes, are more prone to suffer from a labral tear.

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Structures involved

The shoulder joint is comprised of three bones: the upper arm bone called the humerus, the shoulder blade and the collarbone. The link between the arm and the torso is done between the humerus and the shoulder blade. The humerus rests in a shallow socket on the side of the shoulder blade called the glenoid cavity and the labrum helps to add depth to this socket, making the joint more stable.

In the presence of a labral tear caused by repetitive movements, muscles of the rotator cuff, a group of muscles stabilizing the shoulder, are often also irritated.

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Signs & Symptoms that you may experience with Shoulder Labrum Tear

Everyone will react differently after an injury and recovery will depend on the severity of it. A tear of the labrum can cause but is not limited to, pain at the front of the shoulder, a feeling that your shoulder is coming out of its socket, weakness of the arm and limited range of motion. Pain is often felt when trying to lift the arm overhead. Clicking or cracking sounds can sometimes be heard when moving the arm, with a catching sensation in your shoulder.

It is also possible to feel pain during the night when sleeping on the affected shoulder.

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Recovery

Your rehabilitation plan, health, fitness & nutritional status will affect recovery speed. There are multiple types of labrum tears but the most common is called a superior labrum anterior and posterior tear (SLAP).

Most of the time, you can expect to recover functionally from a labrum tear. This means that even though the tear might still be there, you will be able to perform your activities of daily living without pain. It can take a few months to get back to your pre-tear functional level.

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▶ WHAT TO DO with Shoulder Labrum Tear

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 a labrum tear, movement rehabilitation and relearning 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.

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Shoulder Capsulitis

Shoulder Capsulitis

Shoulder capsulitis

Shoulder capsulitis happens when the strong connective tissue surrounding the shoulder becomes thick, stiff and inflamed, causing pain and loss of motion in the shoulder in all directions. It is sometimes called adhesive capsulitis or frozen shoulder.

The exact cause of this condition is unknown, but the risk of suffering from it increases following prolonged shoulder immobilization, a stroke or other shoulder conditions.

People over 40 are more prone to developing this condition and women are more commonly affected than men. Diseases such as diabetes, thyroid dysfunction and cardiovascular diseases can increase the risk of suffering from shoulder capsulitis.

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Structures involved

The glenohumeral joint capsule is involved in this condition. When it thickens, the capsule limits movements of the shoulder. The presence of a natural joint lubricant called synovial fluid also tends to diminish during a capsulitis.

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Signs & Symptoms that you may experience with Shoulder Capsulitis

Everyone will react differently in the event of capsulitis and recovery will depend on its intensity. Shoulder capsulitis generally causes pain and loss of range of motion in the shoulder. This condition typically develops slowly and can last from a few months to a few years. Symptoms of shoulder capsulitis can generally be categorized into three progressive stages.

In the first one, called the freezing stage, the shoulder becomes progressively stiffer and painful. Pain can be worse at night, especially if you sleep on your affected side.

In the second one, called the frozen stage, stiffness in the shoulder joint is important. Pain may begin to diminish during this stage but the range of motion in the shoulder is very limited and muscles start to lose their strength.

The last stage, called the thawing stage, is the beginning of recovery. There is a reduction in pain and a gradual increase in movement.

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Recovery

Prognosis is favorable for the majority of people affected but recovery can take a long time, ranging from one to two years. Your rehabilitation plan, health, fitness & nutritional status will affect recovery speed. Although you can expect to recover from this condition, some mobility restrictions may persist, particularly in regard to range of motion at the shoulder.

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▶ WHAT TO DO

Early Stage

Relative rest is a good way to protect your shoulder and prevent further damage during the first stage, but it’s important to avoid overprotecting your shoulder. It might be necessary to reduce pain-inducing movement and activities. Progressive return to your activities of daily living, range of motion exercises and light cardiovascular exercise will allow better recovery.

Rehabilitation for Shoulder Capsulitis

Follow your practitioner’s advice. It will help you manage the different stages of a capsulitis 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 and functional status.

As per the principles of rehabilitation for shoulder capsulitis, range of motion exercises are an important element of functional recovery. A progressive exercise program 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 range of motion and strengthening exercises as tolerated.

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Trigger points in the pectoralis minor muscle

The pectoralis minor muscle is a small strip like muscle located underneath the pectoralis major. It functions to protect the shoulder and aid in scapular movement and stabilization. This muscle almost always has trigger points in it due to chronic poor posture where the shoulders are rounded. Federal pain from these trigger points will cause pain to be felt in the chest and down the arm.

Trigger points in the scalenes muscles

The scalenes muscles are located in the neck and help with neck movements and inspiration. The anterior scalene runs directly over the brachial plexus that gives nerve and blood supply to the arm. Poor neck and head posture as well as poor breathing mechanics can cause this muscle to become overloaded and develope trigger points. These points will refer pain into the shoulder, arm, and hand. As well as the shoulder blade. When tight, the anterior scalene muscle can put pressure on the brachial plexus causing numbness and tingling felt in the fingers and hand.