Treatment of Impingement Syndrome

[thimawee]

Hello Everyone,

I have a patient who met an acident. No his active flexion and abduction of the shoulder joint at 90 degree make block the joint. After passively flex or abduct that point, patient was able to make full range. Crepititus also palpable at 90 degree. Since last 4 weeks mobilize, active and passive stretching done as treatment.
No Progress .

What can i do as physiotherapy treatment ?

Appreciate your help

Thanks in advace .

Thilini.

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[O-Bear]

I would start with accessory movements; Inferior glide\AP\PA\Scapular control.
Also US and massage might help.

Did you perform any RC tests? what did you find out?
What do you mean 'block the joint'? is the lack of ROM is pain related or mechanical?

[thimawee]

thank you,
I traied accessory movement [at 1st visit], US, and friction [last 2wk]. but after the 90 degree joint lock, actively difficult move. passively can flex and abduct but can feel crepititus. after passing that point active movement are posible.
ROM reduced due to mechanical problem, this condition hapend due to RTA.


RC test- resist internal rotation }
- resist ext. Rot. }
- lift off test } no pain
- bucket handling test }
- drop arm test }

[junior_physiotherapist]

Hello Everyone,

I have a patient who met an acident. No his active flexion and abduction of the shoulder joint at 90 degree make block the joint. After passively flex or abduct that point, patient was able to make full range. Crepititus also palpable at 90 degree. Since last 4 weeks mobilize, active and passive stretching done as treatment.
No Progress .

What can i do as physiotherapy treatment ?

Appreciate your help

Thanks in advace .

Thilini.

Try to check all of :
1. Glenohumeral Joint
2. Suprahumeral “Joint”
3. Scapulothoracic “Joint”
4. Sternoclavicular Joint
5. Acromioclavicular Joint
6. Mechanics of Elevation
7. Adverse Effects of Forward Head Posture;
Shoulder/Thoracic Spine Connection

and To remember:
Adverse Effects of Forward
Head/Rounded Shoulders Posture (Dutton, pp 430, 434)
Mechanical – Janda’s Upper
Crossed syndrome -> scapular malalignment (elevation, anterior tilt, limited upward rotation, etc.) -> impingement syndrome
Neurologic – potential impingement of dorsal scapular n., suprascapular n., and long thoracic nerve n.

Shoulder/Thoracic Spine Connection
1. Bilateral Shoulder Flexion -
thoracic spine extension required
2. Unilateral Shoulder Flexion – upper thoracic ipsilateral side bending/rotation; lower thoracic side contrateral side bending required

[junior_physiotherapist]

According to Cyriax Selective Tension – Shoulder Joint:



1. Articular pattern (capsular vs.
non-capsular).
2. End-feel.
3. Contractile responses (SPL,
SPF, WPL, WPF).
4. Active vs. passive movements
(contractile vs. articular)
5. Stages of arthritis (1, 2, 3)
6. Painful arc
7. Shoulder interpretation - 6
possibilities