Impingement of the Shoulder
Impingement of the shoulder is the name given to a condition which related to the compression suffered by the upper surface of the rotator cuff tendons as it impinges against the under surface of part of the scapula known as the acromion. This process occurs when the arm is moved forward in the typical common movements of the shoulder. Initially the process starts with inflammation and swelling, progressing through several stages to fibrosis and tendon inflammation and eventually to rotator cuff tears and bony outgrowths under the acromion. Cuff tears are much more common in older people as the underlying process is degenerative.
However, people who perform repetitive movements in the overhead position their sport or activity are more prone to impingement and eventually to tears. Gymnasts, swimmers and tennis players are typical athletes who may suffer impingement. The shoulder is a complex and mobile joint which relies on the correct balance of its muscles and ligaments for normal function. Disturbance of the subtle balance of shoulder control can lead to abnormalities of movement which allow impingement to occur and start the process of degeneration.
Physiotherapy management of this form of impingement involves the assessment of the underlying movement dysfunction and then treatment to resolve any joint or muscle shortening and muscle imbalances. Acute treatment involves rest interspersed with regular movement, cutting out aggravating activities and movements, mobilisation techniques, analgesics and static strengthening work to maintain power without bringing on symptoms. Strengthening of the rotator cuff muscles will also be taught, often with resistance bands. Injection of analgesia and steroid can be made under the acromion to settle down acute inflammatory processes.
Once the acute phase has passed physiotherapy aims to bring the ranges of movement and the movement function of the shoulder back towards normal, working at active muscle balance and strengthening. Exercises can progress to active weight training work for all the major muscle groups to strengthen the stabilisers of the scapula and then the rotator cuff and finally the major moving groups such as the deltoid muscles. Once the person is pain free and can perform high levels of strength work with the affected arm they may be progressed to functional work such as the sport or activity they normally pursue. Exercises should reflect the reality of the performance required and the technique continually be examined for both good form and to prevent any poor habits re-establishing themselves.
Author: Jonathan Blood-Smyth