Physical therapy treatment of Shoulder Impingement Syndrome

Shoulder impingement syndrome describes a condition wherein the tendons of the rotator cuff of the shoulder are pinched as they pass between the pinnacle of the upper arm (humerus) and the end of the shoulder (acromion). The rotator cuff is a set of four muscles i.e. subscapularis, teres minor, supraspinatus and infraspinatus. It causes narrowing of the sub acromial bursa.

What is Painful Arc?

Painful arc is initiated when the arm is abducted in anatomical plane in such a manner that the glenohumeral joint glides downwards. In the painful arc if the pain occurs between 60 degrees to 120 degrees it is due to sub acromial shoulder impingement. The gliding doesn't occur properly. Major structures like supraspinatus tendon and the coracoid ligaments are squeezed between greater tubercle and acromion.

 

Symptoms of Shoulder Impingement Syndrome

• Shoulder Pain
• Increased Laxity – usually anterior laxity seen
• Popping or clicking sound
• Rotator cuff weakness
• Muscle asymmetry – Both limbs are examined to see the difference

 

Diagnostic Test for Shoulder Impingement Syndrome

Drop arm test- Impingement / Supraspinatus tear (Rotator cuff tear)

The patient is told to actively elevate the arm accompanied by way of slowly reversing the motion. The arm suddenly drops all at once or the patient reviews ache.

Neer sign - Subacromial impingement

The therapist have to stabilize the affected person's scapula with one hand, while passively flexing the arm at the same time ask him to turned around internally. If the affected person reviews pain on this position, then the result of the test is taken into consideration to be positive.

 

Hawkins Kennedy Test - Subacromial Impingement

The therapist places the affected person's shoulder in ninety degree of shoulder flexion with the elbow flexed to 90 degree after which he internally rotates the arm.

 

Physiotherapy Treatment for Shoulder Impingement Syndrome

Cryotherapy 

The aim of cryotherapy is to reduce pain and minimize swelling of the subacromial structures, thereby increasing the acromiohumeral distance (AHD). Cryotherapy is mostly prescribed in the acute stage.

Therapeutic Ultrasound

It reduces inflammation and promotes healing of injured tissue. Ultrasound is usually applied in constant mode.

 

Stretching Exercise for Shoulder Impingement Syndrome

The mobility of the shoulder joint and scapula is reduced thus stretching exercises are prescribed to decrease tension and help restore normal motion of the shoulder region and arm function.

Posterior stretch for tight posterior capsule:

• The Sleeper Stretch

Lie on the affected side with your upper arm and your elbow both at 90º. With your other hand gently push downwards on the back of the wrist as shown below.

• Posterior stretch in standing

Take your affected arm across your body to rest the hand on the opposite shoulder. Grasp the elbow with other hand and pushing it in the backward direction. Keep pressure on as you push the elbow and hold it for some seconds and release.

 

Strengthening Exercise for Shoulder Impingement Syndrome

Muscle weakness and asymmetry is seen in patients with shoulder impingement syndrome. Resistance exercise proves beneficial mainly progressive resistance exercise to improve condition of muscle. It is often prescribed in chronic stage.

Isometric exercise in external and internal rotation

 

 

Manual therapy Methods for Shoulder Impingement Syndrome

Soft Tissue Mobilization

The patient is positioned with the humerus abducted to 45° with elbow flexed to 90°, and the humerus was externally rotated to a midrange position, typically about 20° to 25° of external rotation. The subscapularis is palpated in the axilla to identify areas of myofascial mobility restrictions or trigger points. Sustained manual pressure is applied.

Contract Relax Method

The patient is instructed to perform internal rotation at glenohumeral joint and maintaining the position for few seconds. The therapist applies an opposite force isometric resistance. The patient then actively externally rotated the glenohumeral joint to the end range.

PNF Technique

Patient actively moves through the PNF flexion-abduction external-rotation diagonal pattern with manual facilitation.