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Published by: theshoulderguy
Common Signs and Symptoms of Subacromial Impingement
Source: http://www.theshoulderguy.com/common-shoulder-conditions/ common-signs-and-symptoms-of-subacromial-impingement/ By Luke Van Every on March 3rd, 2013
Considered the most common type of shoulder pain among adults, subacromial impingement syndrome affects shoulder movement and reduced quality of life if not properly diagnosed and treated. Other parts of the shoulder such as the rotator cuff may also present pain when injured or torn, making it necessary for a clear identification of the patient’s symptoms prior to the creation of a management and treatment plan. Signs and Symptoms The abrasive action of the surface under the acromion against the soft tissues located between the acromion and the humeral head of the shoulder can lead to the following symptoms of subacromial impingement syndrome. Shoulder pain: Pain can occur when the shoulder is moved during an overhead motion. The sensation of pain can increase when the arm is elevated. Tenderness: The affected area can feel tender usually at night when sleeping on the affected shoulder or with the arm above the affected shoulder. Limited range of motion: Pain and inflammation can affect shoulder mobility, limiting its usual range of motion. Oedema: Excess fluid can accumulate at the point of impingement and may be accompanied by warmth at the affected area. 3 Stages of Subacromial Impingement Syndrome Stage 1: Often seen in young adults under the age of 25, impingement is characterised by oedema and haemorrhage in the tendon area. Surgery may not be required. Stage 2: This stage of impingement involves tendinitis at the rotator cuff which may require invasive procedures such as bursectomy and coracoacromial ligament division, often seen in patients between the age of 25 and 40 years old. Stage 3: Impingement is associated with bone spurs and a ruptured tendon often manifested in patients over 40 years old. Anterior acromioplasty which aims to surgically remove a portion of the acromion to create more space for the movement of the rotator cuff may be required. Certain risk factors may increase the chances of impingement: • repetitive overhead throwing activities done by athletes • occupations that perform repetitive elevated shoulder postures such as painting, welding and carpentry • competitive swim training, i.e. freestyle and butterfly strokes • poor posture • hook shaped acromion
Examination of the patient’s history and physical condition is important and this includes documenting properly the patient’s symptoms as constant or intermittent, sharp or dull, aching or burning, and numb or tingling. The patient must also be examined for any presence of neck pain and pain radiating to the arm. A patient’s pattern of symptoms from day through night must be recorded, including changes in symptoms. Other symptoms such as dizziness and sudden swelling of upper extremities may require referral to appropriate specialists.
Understanding the Causes of Subacromial Impingement Syndrome
Source: http://www.theshoulderguy.com/common-shoulder-conditions/ understanding-the-causes-of-subacromial-impingement-syndrome/ By Luke Van Every on March 6th, 2013
Your shoulder is made up of bones and joints that are connected together by several ligaments, tendons and muscles. With the support of these soft tissue structures, the shoulder is able to function with a wider range of motion than any other joint in the body. The shoulder functions to predominantly support the hand in various movements that allow it to perform both high powered activities, such as throwing, and to perform other complex tasks that require more dexterity. Often, however, adults experience shoulder pain related to stress loading and inflammation of structures identified as subacromial impingement (pain) syndrome which limits the affected shoulder’s range of motion and functional abilities. Due to the complex system controlling shoulder joint movements, a clear determination of the etiology or cause or set of causes of subacromial shoulder pain is essential for any treatment plan to be effective. Possible causes of Subacromial Impingement Pain Syndrome Posterior shoulder tightness: Overuse or overloading of the shoulder may cause tightness and restriction of the rotator cuff muscles and posterior capsule of the shoulder joint. This can cause the humeral head (ball) to shift upwards and potentially impinge during movements above shoulder height. Poor shoulder blade mechanics: For proper pain free function the shoulder complex is reliant on co-ordinated movements both of the arm and the shoulder blade. Abnormal shoulder blade postures, muscle activation patterns and timing have been shown to affect shoulder blade function and contribute to many shoulder pain states. Shoulder instability: An inability to stabilise the shoulder joint possibly due to inherent joint laxity or inhibition of key stabilising muscles through pain or fatigue may lead to superior migration of the humeral head and impingement of the rotator cuff tendons and bursa. Rotator cuff tendinopathy: When the rotator cuff is injured or becomes inflamed possibly due to an unaccustomed loading episode or change in training volume or speed, the swollen
March 8th, 2013
Published by: theshoulderguy
portion may become impinged during overhead movements and irritate the bursa. Various factors have been found to be related to rotator cuff tendinopathy including chronic submaximal loading (overuse), acute unaccustomed loading, poor nutrition, poor blood supply to the affected area possibly due to smoking, age-related degeneration and trauma. Subacromial bursitis: The acromion refers to the outermost point of the spine of the shoulder blade. Underneath the acromion is the subacromion bursa, a fluid-filled space between the acromion and rotator cuff tendons. The rotator cuff consists of muscles and tendons that are responsible for controlling and assisting arm movements. The bursa facilitates the smooth movement of the rotator cuff. However, when the bursa under the acromion is inflamed in a condition known as subacromial bursitis, the bursa and rotator cuff can get pinched under the acromion during overhead motions, adding to the pain radiating from the inflamed bursa. Overload, overuse or repeated irritation of the rotator cuff can lead to inflammation under the acromion. Rotator cuff tear: An injured rotator cuff can result in partial or full-thickness tears. While the majority of tears lie on the under (articular) surface of the rotator cuff, parts of the torn cuff tissue may also impinge under the acromion, causing pain during motion. The exact etiology of subacromial impingement (pain) syndrome is still the subject of ongoing debate although studies indicate that a combination of factors can contribute to the development of the condition. Thus, diagnosis must involve a thorough history and physical examination of the patient.
syndrome. The following stages are based on Dr Charles Neer’s now outdated model. For a more modern perspective click here. Stage 1: Impingement can initially involve acute bursitis or inflammation of the bursa, the fluid-filled pocket below the acromion which facilitates joint movement at the shoulder. It is accompanied by oedema and haemorrhage under neath the acromion. If extrinsic (subacromial) compression of the rotator cuff and bursa continues, bursal adhesions and rotator cuff tendinopathy will ensue. Stage 2: The second stage most commonly involves injury to the supraspinatus tendon, which makes up the top portion of the rotator cuff. When the fibres of the tendon become frayed, a partial-thickness tear may develop. Stage 3: Over time, the partial thickness tear can progress to full-thickness or complete tear of the tendon that can disable movement of the affected shoulder. Treatment Subacromial impingement syndrome may be treated through rehabilitation of the affected joint and surgery to remove any mechanical obstacles at the subacromion and/or to repair large tendon tears. Physiotherapy through a supervised exercise programme is ideally the first treatment option that when undertaken at an early stage, can be an effective treatment plan that may eliminate further need for surgery. A physiotherapist supervises a series of exercises aimed at helping the patient to: • Relearn normal movement patterns while elevating the arm • Reduce subacromial stress loading and remodel collagen tissue • Retrain conscious rotator cuff and scapular muscle activation to avoid unwanted joint motion • Low load endurance training to strengthen shoulder muscles and tendons of the rotator cuff The physiotherapist will gradually incorporate home or gym based self-directed exercises that the patient can perform to boost rehabilitation. Improvement can occur after several weeks of consistent treatment sessions but for longer lasting results a graduated rehabilitation program of at least 3 months is required. Shoulder pain arising from subacromial impingement syndrome can lead to more serious damage in and around the shoulder joint. Prompt treatment and rehabilitation can prevent further degeneration of damaged tissues and tendons and restore the shoulder’s range of motion for a pain-free way of life. One such treatment program with proven results is
Why You Should Seek Treatment For Subacromial Impingement Syndrome
Source: http://www.theshoulderguy.com/common-shoulder-conditions/ why-you-should-seek-treatment-for-subacromial-impingement-syndrome/ By Luke Van Every on March 6th, 2013
Shoulder pain is a common problem among adults and is often a symptom of an underlying shoulder condition such as subacromial impingement syndrome. When left untreated, degeneration of the rotator cuff tendons and aberrant muscle patterning can progress, leading to more joint pain and restricted range of motion that can reduce one’s quality of life. Thus, early detection and prompt rehabilitation of the causes of shoulder dysfunction is vital for the management of subacromial impingement syndrome. Natural history of subacromial impingement syndrome Subacromial impingement syndrome is generally caused by dysfunctional overhead arm movements. This shoulder condition is closely linked to the deterioration of the rotator cuff and surrounding tissues and incidence progresses with age. Work or athletic activities characterised by repetitive overhead arm movements such as weight lifting, swimming, tennis, painting, mechanical repair and stocking shelves can increase one’s risk of developing shoulder impingement
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