Telephone: 01788 560646
Email: reception@rugbyosteopaths.co.uk
69 Albert Street, Rugby,
Warwickshire, CV21 2SN.
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Impingement

Definition

Shoulder Impingement Syndrome, also called subacromial impingement, painful arc syndrome, swimmer's shoulder or thrower's shoulder, occurs when the tendons of the rotator cuff muscles become irritated and inflamed as they pass through the subacromial space, the narrow passage between the head of the humerus and the acromion. This can result in pain, weakness and loss of movement at the shoulder.

Cause of Injury  Repetitive or forced narrowing of this space will result in impingement. So constantly using your arm above your head, like swimming, throwing or decorating may cause this. Poor posture that results in the shoulder blade(scapular) anteriorly rotating will restrict this space for example slumping with “round shoulders” or sitting at a poor work station for too long.

The constant or forced narrowing of this tight space will start to cause local tissue damage and swelling. This can lead to the acromion developing a bony spur from repetitive trauma, the coracoacromial ligament can become thickened or the supraspinatus or the subscapularis tendon (parts of the rotator cuff) becomes bruised, inflamed and eventually will start to tear.

Symptoms The most common symptom is pain on the front or side of the shoulder often referring into the biceps area. The pain often is reproduced when bringing the arm out to the side and will often resolve when the arm is above the head (painful arc syndrome). It can be painful to sleep on the effected side. Arm weakness can develop.

Treatment. Treatment will follow the following pathway

  • LOCAL TREATMENT
     
  • POSTURE
     
  • SCAPULAR MOVEMENT
     
  • MUSCLE SEQUENCING
     
  • MUSCLE PATTERNING

Local treatment will include advice on modifying the activity causing the injury, commonly overhead activity.  We will also give advice on icing the shoulderand taking appropriate anti-inflammatory drugs. Soft tissue massage, articulation and sometimes acupuncture to the local tissues will be given to create the conditions for tissue repair.

Posture will affect how the shoulder blade is positioned. So advice on posture and treatment of the upper back and neck with massage, articulation and manipulation will improve the resting position of the scapular.

Scapular movement is improved by relaxing and stretching the muscles that attach the scapular to the body, the scapular to the arm and the body to the arm. This improves gliding of the scapular throughout the arc of arm motion. Once the scapular has been freed then we can start the rehabilitation exercises

Muscle sequencing  After an injury to the shoulder the muscles often stop working together. Some of the larger muscles like the pectoralis major and latissimus dorsi (pecs and Lats) will start firing before the shoulder joint has been stabilised. By relearning the coordination between joint stabilization and the initiation of arm movement through specific exercises you can help the shoulder remain injury free during activity.

Body Patterning This involves evaluation of how the body functions as a unit. Analysing movement patterns such as the primary movements squatting, lunging, pushing, pulling, pressing and twisting and using these to detect and treat dysfunction. This is a vital stage in the treatment and prevention of injury re-occurrence.     

When the damage to local structures such as the rotator cuff muscles or the acromion is too severe to heal the therapist will advise you accordingly and may suggest seeking the advice of our Specialist Orthopaedic Surgeon.

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Rugby Osteopathic Centre, 69 Albert Street, Rugby
Warwickshire, CV21 2SN, Tel: 01788 560646, Fax:01788 571318
Email: reception@rugbyosteopaths.co.uk
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