Shoulder impingement syndrome and Physical Therapy

Shoulder impingement results from the compression of the rotator cuff muscles under the coracoacromial arch.
Inflammation and pain occurs and is aggravated by the shoulder and arm movements.Pain is felt on antero lateral aspect of shoulder radiating down to mid arm at times.
It can be confirmed with Hawkins-Kennedy impingement test and Neer's impingement test.

ETIOLOGY of shoulder impingement syndrome is multifactorial-

1. Acute trauma: fall on to the shoulder or direct blow on the shoulder.

2. Chronic injury from:
a) Repeated overhead activity like throwing, lifting and catching.
b) Improper postural habits leading to muscle imbalances between deltoid and infraspinatus, teres minor, subscapularis or between supraspinatus and gravity. As a result one group of muscles become tight and other gets stretched and become weak.Loss of rotator cuff strength causes superior migration of humerus resulting in impingement.

3.Outlet impingement due to subacromial osteophytes, hooked or beaked acromion shape, thickened or calcified coracoacromial ligament.


TREATMENT GOALS

1-Decrease the inflammation

*Cryotherapy-Use ice packs for a maximum of 15 minutes, 3 times a day
*Anti inflammatory medication
*Relative rest-Avoiding aggravating and loading activities like overhead reaching and lifting heavy weights in order to prevent further injury to the rotator cuff.

2-Improve posture and shoulder ROM

*Gentle stretching exercises and ROM
-Downward and backward pulling of both the arms with the hands clasped behind the back
-Scapular retraction exercises
-Codman pendular exercises
-Horizontal adduction stretch
-Triceps stretching
-Corner stretch-to stretch the front of the shoulder and the pectorals muscles by pushing against a wall in the corner of the room.
-Biceps stretch

* Sit with back fully supported and work with shoulders being close to the body.

3-Strengthen the rotator cuff muscles and scapular stabilizers.

*Bilateral shoulder extension exercises in prone or standing position.
*Resisted shoulder external and internal rotation in the gravity eliminated plane.
*Supraspinatus strenthening by resisting shoulder abduction in empty can position of the hand.
*Bilateral shoulder abduction in prone
*Supine press
*Biceps curls