Shoulder impingement syndrome
The shoulder is a joint with an extremely big range of motion and it is exactly that ability to perform a great deal and range of movement that can cause different inflammatory and pathological changes in the shoulder region. Shoulder impingement syndrome is one of the most common overuse syndromes of the shoulder region leading to pain and range of motion limitations.
Rotator cuff is a group of muscles and their respective tendons which surround the shoulder joint, ie. connect it to the humerus (upper arm bone). This group encompasses m. supraspinatus, m. infraspinatus, m. subscapularis and m. teres minor whose roles are to ensure abduction and rotation of the arm in the shoulder and provide active stabilization and control for the joint.
Degrees of shoulder impingement syndrome:
1. Inflammation, pain and swelling of rotatory cuff structures
2. Tendinitis and bursitis – tendons and bursa get inflammed
3. Damage to the rotatory cuff tendon tissue – partial or complete tear of the tendon
With shoulder impingement syndrome the pain mostly happens on the m. supraspinatus tendon situated between two bones, the humerus and the scapula and when the arm gets raised above the shoulder level the stress and pressure on the tendon ncrease significantly due to collision of said bones and the tendon. Excesive load on the tendon happens when it gets rubbed against the acromion on the scapula or the humerus and often the tendon gets pinched between the two bones. The added friction causes degenerative changes on the tendon tissue leading to inflammation and limitations of shoulder mobility which intensifies over time if it is not treated properly and timely. Impingement syndrome occurs during constant repeating of certain movements where the supraspintaus tendon gets overloaded and the space between the bones and the tendon gets narrowed producing added stress on the tendon. It is common with sports activities or jobs that require constant lifting, swinging or movements of the arm above the shoulder level, eg. in tennis, swimming, volleyball, basketball, construction workers, painters, etc.
Symptoms include pain at the upper posterior part of the shoulder during arm abduction or lifting above shoulder level, pain often happens during the night when we add pressure on the shoulder by lying on it and sharp pain while trying to put the arm behind the back is a specific symptom of this syndrome. With time and if the syndrome is not properly treated the pain and range of motion limitations intensify and cause more rigidness, pain and difficulties during shoulder movements.
Treatment of this syndrome is commonly done through a conservative apporach, except in rare cases where the tendon tissue gets torn completely and a surgical approach of tendon reconstruction is needed. In acute phase of therapy physical therapy methods are used to reduce inflammation, pain and swelling and in the following functional phase of therapy range of motion should be developed and the space between the bones and the tendon should be made wider to relieve stress and friction on the tendon. Stretching exercises of the shoulder, scapular, neck, upper arm and chest muscles should be used to increase flexibility and joint mibility and progressive strenghtening of rotatory cuff along with shoulder stability and control through proprioceptive exercises should also be implemented. Rehabilitation, in most shoulder impingement cases, lasts up to 1 month.
Prevention: proper performance technique of arm lifting and abduction, with proper muscle activation, developing of flexibility and strenght of all shoulder muscle groups in order to prevent possible deficits in either ability that can lead to shoulder impingement, mobility exercises in all plains of shoulder movement, etc.
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Program duration is 45 days. If you start today on 31.01.2023., the completion of the rehabilitation program will be on 17.03.2023.