Wellness Articles

Shoulder Impingement Syndrome

Tips for treatment and prevention of many injuries provided by Vancouver Chiropractor and Sports Therapy

Along with rotator cuff strains, shoulder impingement is one of the most common injuries to the shoulder. It is often due to repeated irritation or pinching of the biceps brachii or rotator cuff tendons as they pass between the coracoacromial arch and the greater tuberosity of the humerus.

One is at increased risk to sustain an impingement injury if they have one or more of the following:
1. Engagement in repetitive heavy overhead activity- sport related activities (tennis, volleyball, swimming, baseball, and softball), painting, welding, construction, etc
2. Acute rotator cuff strain
3. Age related weakness of rotator cuff
4. Arthritis of the AC joint
5. Inadequate warm up
6. Neck issues

Signs and Symptoms
1. Episodic reoccurrence of shoulder pain- in later stages, the pain may present similar to a toothache and may be worse at night.
2. Increased discomfort when engaging in overhead activities such as sports or work
3. Local tenderness over side (greater tuberosity) and top (acromion) of shoulder
4. Referred pain to lateral deltoid and posteriolateral arm
5. Painful arc during flexion (bring arm forward) especially between 70-120º
6. Painful “catch” above 120º but has full range of motion (ROM) in abduction and flexion
7. Pain placing hand behind head when elbow is near the ear (Apley’s I) or when placing hand to middle of the back when elbow is near waist (Apley’s II)
8. Possible pain and limitations to bicep movement when bicep tendon is involved
9. “Crunching”, “snapping”, or “cracking” sounds are heard with movement

Treatment
Acute
1. Reduce pain and swelling via electrotherapy (IFC, TENS) and hydrotherapy (cryocuff)
2. Spinal adjustments if indicated
3. Nutritional advice: inflammation control and connective tissue support
4. Home care: ice massage and rest

Sub-acute
1. Rehabilitation exercises for strength and stretching (PNF, pendulums, etc)
2. Continue with spinal adjustments
3. Shoulder adjustments
4. Home care: hot and cold transfer, stretch and strength program, implement return to activity regime

Post-acute
1. Continue with shoulder and spinal adjustments
2. Nutritional advice to reduce incidence of re-injury.

If caught early enough, there is a high probability once the issue is resolved there is low risk of re-injury. However, age and lifestyle factors must be be considered.

Have a great day,
Dr. Crysta Serné
Vancouver Chiropractor and owner of Vitality Clinic



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