Shoulder Impingement

[physiobob]

Impingement refers to mechanical compression and/or wear of the rotator cuff tendons. The rotator cuff is actually a series of four muscles connecting the scapula (shoulder blade) to the humeral head (upper part of the shoulder joint.) The rotator cuff is important in maintaining the humeral head within the glenoid (socket) during normal shoulder function and also contributes to shoulder strength during activity. Normally, the rotator cuff glides smoothly between the undersurface of the acromion and the humeral head.

This download is a short practitioner TIP or overview of what shoulder impingement is. This could be used as a simple handout for your patients as well as it is not an at length discussion rather a brief overview.

Author : The American Orthopaedic Society for Sports Medicine.
Author Email : [email protected]
Country of Origin : USA

Ref URL : http://www.sportsmed.org/

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[Lgodin]

Hi, I find that we have to go to the source of the problem to get results. Find the source of impingement. Why do we have an irritation of the rotator cuff in the first place? Look at the glides of the G/H joint as well as the resting position of the humeral head in the glenoid cavity. Is there limitation of the inferior and posterior glides? Do we have a resting position which is anteriorly? There will be weakness of the cuff, no doubt but go to the source and don't get fooled by the obvious.

Louis Godin RPT, FCAMT

[physiobob]

Hi, I find that we have to go to the source of the problem to get results. Find the source of impingement. Why do we have an irritation of the rotator cuff in the first place? Look at the glides of the G/H joint as well as the resting position of the humeral head in the glenoid cavity. Is there limitation of the inferior and posterior glides? Do we have a resting position which is anteriorly? There will be weakness of the cuff, no doubt but go to the source and don't get fooled by the obvious.

Louis Godin RPT, FCAMT

I couldn't agree with you more. One must really look at 95% of should injuries as some for of impingement. What therefore is the cause. To consider this one has to look at all joints involved in shoulder motion including, stenoclavicular, acromioclavicular, glenohumeral (least likely problem!) scapulothoracic, thoracic spinal extension, upper lumbar extension, spinal rotation etc. Then of course look at what the body does with the available motion that it is presented with. i.e. To have mobility does not mean that you will use it effectively. What about the recruitment timing and patterning of the involved muscles.

Then we must consider diet, physiology, training/over training, equipment and it's suitability to the client (e.g. tennis racket or golf club). The list goes on and perhaps we could and many have write dedicated books to should assessment and treatment alone.

I find perhaps the biggest hurdle is that shoulder symptoms often develop over a long time. Thus their causes are fundemental movement patterns in the patient. Once the issue turns to pain the resolution of that pain is not as overnight as the onset. Education is very important for the client in this reguard.

[karamat]

hi,
you both may be right. I have come across in dealin with the problem of impingment too often. I have seen varying causes of the problems.
1- age:
it is more common in people with age more than fifty. the impingement start due to the poor psoture patern as the people in in this age group have a tendency of increase thoracic lordosis, decrease proprioception and delayed recruitment of the of the musle fibres.

2- it is common in the middle age population as well. During my clincal experience i have found that those people who are working more in the middle range of shoulder felxion, develop the problem. e.g. those who are frequently involved in jobs like putttings things in Shelves, puthing soaked cloths in the wires over head, throwing balls in the middle range as in cricked etc.
the supraspinatus impingement can be confirmed by applying moderate dose of ultrasound with out moving the head(transjucer) on the to of the shouder (supraspinatus proint), placing the arm in behind the scapula in medial rotation. the patient complain of shooting pain after a minte of constant application. I found this working in the other tendenitis problems as well where i doubt any other cause of the problem.

ther are of course other khown causes as well