Feb 12, 2018
Background Shoulder impingement syndrome is a condition where your shoulders rotator cuff tendons are intermittently trapped and compressed during shoulder movements This causes injury to the shoulder tendons and bursa resulting in painful shoulder movements. Rotator cuff pain is common in both young athletes and middle-aged people. Young athletes who use their arms overhead for swimming, baseball, and tennis are particularly vulnerable. Those who do repetitive lifting or overhead activities using the arm, such as paper hanging, construction, or painting are also susceptible. Pain may also develop as the result of a minor injury. Sometimes, it occurs with no apparent cause. It affects the rotator cuff tendon, which is the rubbery tissue that connects the muscles around your shoulder joint to the top of your arm. An impinging shoulder will often improve in a few weeks or months, especially with the right type of shoulder exercises, but occasionally it can be an ongoing problem and a few people may need surgery. Symptoms and Diagnosis Shoulder impingement can start suddenly or come on gradually. Symptoms include: - Pain in the top and outer side of your shoulder - Pain that's worse when you lift your arm, especially when you lift it above your head - Pain or aching at night, which can affect your sleep - Weakness in your arm Your shoulder won't usually be stiff. If it is, you might have a frozen shoulder instead. Rehabilitation Hold an ice pack (or a bag of ice cubes or frozen vegetables) to your shoulder for around 20 minutes several times a day – but don't put it directly on your skin, wrap it in a towel first. Take painkillers – anti-inflammatory painkillers (such as ibuprofen) or paracetamol may help. Your GP can prescribe stronger painkillers if needed. Mobility and stretching Stretches can be done on a daily basis assuming there is no pain. Stretching must be done regularly and continued throughout the rehabilitation process. Below are some important stretches would should be performed in order to encourage full range of motion and improved posture. Chest stretch - Place one forearm arm against a fixed point such as a doorframe or corner of a wall. - Gently lean forwards and turn away from it to stretch the chest muscles. - Again, hold the position for 20 to 30 seconds and repeat 3 times. The athlete should feel a gentle stretch in the front of the shoulder but not pain. Supraspinatus stretch - Place the hand on the lower back and use the other hand to pull the elbow forwards. - Keep your hand on your lower back. - You should feel a gentle stretch at the back of the shoulder. - Hold for 20 to 30 seconds and repeat 5 times assuming there is no pain. If it is painful then discontinue. Anterior shoulder stretch - Grasp something above you such as a doorframe (or something similar if not tall enough). - Move forwards leaving the arm behind to stretch the front of the shoulder and chest muscles. - Hold the position for 20 to 30 seconds and repeat 3 times. - The athlete should feel a gentle stretch in the front of the shoulder but not pain. Posterior shoulder stretch - Place one arm across the front and pull it in tight with the other. - The athlete should feel a gentle stretch at the back of the shoulder. - Again, hold the position for 20 to 30 seconds and repeat 3 times. The athlete should feel a gentle stretch in the back of the shoulder but not pain. Stretching should be done as soon as pain will allow and maintained throughout the rehabilitation process and beyond. Little and often is generally better than a big effort for a few days and then forgetting it as soon as the athlete feels the injury has settled down. Strengthening Exercises The strengthening exercises below are aimed at strengthening the rotator cuff muscles which are involved in stabilising the shoulder joint. There is also an emphasis on the upper back muscles such as the Rhomboids and Serratus Anterior which improve posture. Always make sure any strengthening exercises are pain-free. If there is any pain, stop immediately. External rotation lying - The athlete lies on their side with the arm to be worked on top. - The upper arm should be resting on your side and the elbow bent so that the hand points towards the floor. - Rotate the shoulder so that the hand moves up, towards the ceiling as far as possible. - Slowly return to the starting position. - Start with a light weight of around 2kg. - Aim for 10 to 20 repetitions. - This exercise may be performed daily. This exercise can also be performed in a standing position with resistance band. Internal rotation lying - Lay on your side with the arm to be worked on the bottom. Start with the forearm parallel to the floor. - Rotate the shoulder so that the forearm moves towards the stomach and hand points upwards. - Slowly lower the weight back to the start. Start with a light weight of around 2-3kg. - Aim for 10-20 repetitions initially. This exercise should be performed daily. This exercise can also be performed in a standing position with resistance band. Once these exercises can be performed easily and progressions have been made with both weight and repetitions then the above exercises can be progressed by performing them in an abducted position: External rotation in abduction - The athlete stands with the arm abducted (raised to the side) to 90 degrees - so the arm is parallel to the floor. - If it is easier the elbow can be rested on a chair or bench (in a seated position). - The elbow should also be bent to 90 degrees. - Using the elbow as a fixed point, rotate the shoulder so that the hand points to the ceiling. - Slowly return to the starting position. - Start with a 2-3kg dumbbell, or use a cable pulley machine or resistance band. -Aim for 10-20 repetition initially. It is also important in all shoulder rehabilitation to strengthen the muscles of the shoulder girdle in order to maintain correct shoulder biomechanics. The shoulder girdle consists of the shoulder blade (scapular) and the collar bone (clavicle). The following exercises are designed to strengthen the shoulder girdle. Retraction The athlete aims to pull the shoulder back, whilst keeping the arm straight and the head still. The only thing to move when doing this exercise should be the shoulder. Aim to build up gradually (without a weight at first) from 3 sets of 10 repetitions to 3 sets of 30. Once 3 sets of 30 are reached with no adverse affects, then the weight can increase.