Shoulder Impingement

Bike

Shoulder
Impingement

Shoulder impingement is one of the most common shoulder Shoulder Impingement 2 conditions seen in physical therapy(1) The shoulder is a highly mobile joint, and as such requires control from multiple structures including muscle ligaments and tendons. Sometimes, these structures can Shoulder Impinegment become inflamed due to traumatic injury or overuse. There is a narrow space in the shoulder between the bones where the tendons of the rotator cuff muscles pass. This space is narrowed with overhead activities and usually does not cause pain. Sometimes however, the tendons or bursa that reside in this small space become inflamed, causing compression of tissue found in the subacromial space (area beneath the top of the shoulder blade and the humerus , or arm bone). The compression on these tissues can cause pain, loss of function of the shoulder and improper joint mechanics. This typically presents as pain with overhead activity, limited range of motion and sometimes an inability to reach ones back pocket.
Sometimes, improper mechanics of the shoulder can lead to shoulder impingement symptoms. During normal arm movement, the humerus (or arm bone) roll and downslide to prevent pinching of the tendons of the rotator cuff. If the joint mechanics are altered due to injury and downslide is not present, the arm bone can ride up and pinch the structures of the subacromial space underneath the acromion causing pain.

What to expect at Redmond Physical Therapy (evaluation and treatment)

A comprehensive exam to determine if your shoulder pain is likely a result of impingement
A specific exercise program with manual therapy techniques to facilitate proper joint mechanics if indicated. There is evidence that manual therapy plus exercise is more effective than exercise alone for increasing strength, decreasing pain and improving function in patients with shoulder impingement syndrome.2
Modalities to help relieve swelling and pain if indicated (estim, ice, ultrasound)
A home exercise program

References

Millar, AL, et. al. Epidemiological study of incidence of shoulder conditions. JOSPT, 36: 403-414, 2006
Bang, MD, et. al. Comparison of supervised exercise with and without manual physical therapy for patients with shoulder impingement sundrome. JOSPT, 30: 126-137, 2000.

Author: Evan Martina PT,DPT, CSCS