Shoulder Impingement Syndrome

Shoulder pain is the third most common musculoskeletal disorder, following low back and neck pain (Donatelli).   Because of the mechanical demands placed on the shoulder, it is susceptible to numerous soft-tissue injuries.   One of these injuries is called shoulder impingement syndrome.  It is the result of compression of the soft tissues i.e. most typically, the rotator cuff tendon, within the sub-acromial space.  Impingement results from the cumulative stresses of repetitive shoulder motion such as pitching or sustained overhead activity such as painting.  This repetitive stress can lead to tendonitis, rotator cuff tears, bone spurs, or bursitis.

Impingement syndrome can be classified in two ways – external vs. internal and primary vs. secondary.  An external impingement affects the superior surface of the humeral soft tissues in the sub-acromial or coraco-acromial region.  Applicable clinical tests include the Neer and Hawkin’s/Kennedy tests.   An internal impingement may affect the undersurface of the rotator cuff, the posterior labrum, and is, more specifically, a post/sup impingement.  Clinical exam may produce post/sup shoulder pain with passive ER which can be alleviated with a passive posterior humeral glide.  A primary impingement is caused by the structural anatomy of the sub-acromial region.  X-Rays can determine an abnormal variation in the shape of the acromion process.  A type 3 “hooked” acromion may require surgical intervention to correct.  On the other hand, a secondary impingement is the result of dysfunctional biomechanics of the shoulder joint.  It may be due to weakness of the rotator cuff muscles, poor posture, gleno-humeral joint stiffness, thoracic hypomobility, and/or in-coordination/weakness of the scapular stabilizing muscles. And that is what WE treat at OrthoWell?

“I play tennis and developed pain in my shoulder so strong that I could not even sleep, let alone play!  After the very first treatment (ART combined with joint mobilization) 80% of my pain was gone!  I am practically pain free now after 4 visits.  Thank-you Chris!  Great job!” – DK

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