Impingement syndrome - shoulder pain

Do you feel pain in your shoulder? You cannot lift your arm above your head? Have you been told that you suffer from impingement syndrome, but you don’t know what it exactly means? In this article we will try to explain you this problematic condition and we will also recommend you an option of effective therapy.

It is a painful overloading of the soft tissues (tendons, ligaments) in the area of the shoulder joint. Long term overloading can consequently cause formation of functional problem (overloaded muscles, tendons, bursae), structural problem (ruptures in the muscles, lost elasticity of the ligaments…), and serious movement restriction of the shoulder also called frozen shoulder.

CAUSES OF IMPINGEMENT SYNDROME

anatomie ramenni kloubThe problems occur usually after 40 years of age. The ligaments are irritated between the collarbone and shoulder blade (coracoacromial ligament), which is during abduction irritated by the head of the humerus bone and soft structures.

Excessive physical burden on the shoulder joint

Long term overloading of the muscles of the shoulder girdle results in incorrect body posture and incorrect performance of the basic movement stereotypes in the shoulder girdle. That occurs very often during work (sitting in front of a computer, driving car for longer period of time, manual profession…). Muscles are also overloaded during sport, where the arm is often above the head (volleyball, tennis, basketball, handball, weight training, etc.).

Injury mechanism

The most common injury causing impingement syndrome is falling on the knee - falling on skis, bicycle, hitting a barrier in floorball or ice hockey. The soft tissues of the shoulder girdle get bruised during the injury. The bruise causes swelling and increased tension in the muscle, whose goal is immobilization for protection from any further damage. The result of immobilization are weakened muscles of the shoulder, the shoulder loses stability and chronic pain appears.

The injury is also often causing bruising or damage in the rotator cuff, whose part is often painful supraspinatus muscle of the shoulder blade. Sensitive on touch and painful is often the attachment of the biceps (caput longum m. biceps brachii). The subacromial bursitis is also often damaged and sensitive to pain.

MANIFESTATIONS OF THE IMPINGEMENT SYNDROME

Along with unpleasant pain there is a restriction in the shoulder mobility. Usually it is, given by the affected muscles, restricting the arm movement above the head, that is when you are able to lift your arms to 60°, but with every additional degree up to 120°, the pain significantly grows. Strong pain is also occurring during inner rotation in the shoulder joint (placing the hand between the shoulder blades), as opposed to outer rotation. During chronic or more serious phases, the pain in the shoulder makes peaceful sleeping basically impossible.

Even though the acute pain or overloading may slightly disappear, and the restricted movement area is improving, there is a danger that this condition will become chronic. In principle it is a protective mechanism of the organism, when muscles and soft tissues reflexively increase their tension (they will get „stiff”) and they will stabilize the damaged brain joint. This neuromuscular reaction restricts another damage to the tissues.

Therefore it is important to start with a therapy during confirmed diagnosis, and fully heal the shoulder. It is not ideal to wait whether the pain will fade away by itself. In most cases the acute pain develops in chronic pain, and the treatment then becomes longer and more difficult. Long lasting pain at the same time restricts the person at work, during sport and common daily activities.

CONSERVATIVE TREATMENT

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During first visit by orthopedist you will be prescribed to follow a treatment with non-steroid antirheumatics (anti-inflammatory drugs) in form of pills, ointments or gels. Pharmaceutical products only help with the treatment of the results of the problem: they lower pain, lower the muscle tension and swelling. Most doctors recommend within the rehabilitation also magnetotherapy, laser treatment or ultrasound. But these methods don’t have very high effect. The treatment is taking too long, it is painful and tiring. If the situation doesn’t get better, the doctor will recommend the patient a surgical treatment.

PHYSIOTHERAPY

For a complete resolution of the problems, which will stop the transition of the syndrome to a chronic stage, you can find solution only in a complexive modern physiotherapy in combination with shockwave therapy.

For lowered muscle tension, released stiff joint capsule, ligaments and tendons we apply techniques of the soft tissues and mobilization. In case where the cause of the pain is not inflammation, we can apply a hot towel roll. For optimal muscle tension in the so called functional chains and for increased movement range in the joint, we recommend to choose techniques on a neurophysiological basis (Vojta method, proprioceptive nerve-muscle facilitation, dynamic neuromuscular stabilization, etc…).

Within complexive view we notice another functional change in the area of the nape, elbow, forearm or hand, thoracic spine, ribs but also pelvis. Every functional defect has consequences on a more distant parts of the body because of the connected muscle chains.

Exercise instructions - frozen shoulder

SHOCKWAVE THERAPY OF THE IMPINGEMENT SYNDROME

Part of the effective modern physiotherapy, which leads to faster withdrawal of pharmaceutical treatment and regaining back the mobility in the shoulder joint, the high-energy focused shock wave therapy is combined with radial shock wave therapy.

The shock wave is applied 2-4x within 7-14 days, and the pain is relieved often times after first application and it lasts even during the night. At the same time the movement in the shoulder joint gradually increases and it is painless.

If the shockwave therapy is led along with physiotherapy, the syndrome can be treated quickly and permanently.

Very good addition to the therapy is also application of the kinesio tape (flexible cotton band). Functional tape works even after you leave our clinic, it works gradually on optimization of the muscle tension and at the same time is stabilizes the shoulder joint in an optimal position. It is therefore helpful addition to the complexive treatment of the impingement syndrome.

Outer rotation in the shoulderRelieving the outer rotator cuffs



Author: Mgr. Iva Bílková, FYZIOklinika fyzioterapie Ltd, Prague, Czech Republic

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