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Shoulder Impingement Syndrome

Shoulder Impingement Syndrome

The shoulder joint has the most mobility among ball and socket joints in the body. This joint is subject to damage and wear. As a result of shoulder impingement syndrome, various factors cause pain and restriction in the rotator cuff tendon (especially the supraspinatus tendon) between the upper arm and the upper shoulder (acromion). This complication is especially common in people who frequently raise their hands above their heads. Wearing clothes or sleeping on the affected shoulder can cause pain. Applying too much pressure, changes in the tissue due to wear, accumulation of calcium in the tissue, or inflammation can cause shoulder impingement syndrome. In all these cases, the muscle experiences abnormal tension (imbalance in the muscle system and fascia tissue). There are different methods to restore balance and relieve pain.
In general, the sooner treatment is started, the more likely it is that the symptoms will improve without the need for surgery.

Shoulder Impingement Syndrome

What Causes Shoulder Impingement Syndrome

The causes of shoulder impingement syndrome are:

OveruseMany sports movements and activities require continuous movement of the shoulder. For example, when painting a building, when you raise your hand to paint a wall, the shoulder muscles are working hard to ensure that the movement is mechanically safe. As the muscles get tired, the movement pattern of the hand changes, and as a result, the subacromial space gradually decreases until the entrapment syndrome occurs.

  • Injury

As a result of various events, it is possible to hit the shoulder directly. The supraspinatus tendon is located along the side of the shoulder and is usually affected by injury. Damage to the supraspinatus hurts its ability to maintain the alignment of the shoulder joint. As a result, the change in the position of the shoulder joint causes a decrease in the subacromial space and ultimately the occurrence of shoulder impingement syndrome.

  • Structural disorders

Any structural damage or destructive changes in the shoulder joint can lead to shoulder impingement syndrome. Common structural disorders include:

  • Shoulder labrum tear
  • Rupture of the rotator cuff muscle
  • The formation of bony appendages caused by changes related to joint inflammation
  • Poor shoulder mechanics

When moving the shoulder, the structures of the humerus, scapula, clavicle, and spine are used. Each of these structures plays an important role in maintaining the subacromial space and improving movement mechanics. Any disturbance in these parts can lead to shoulder impingement syndrome. For example, weakness in the muscles around the scapula reduces its ability to rotate upwards and ultimately reduces the subacromial space.

  • Bad posture

Body posture has a significant effect on maintaining shoulder stability. Bad posture includes bending the shoulders and spine. In this case, the scapula bone is in an inappropriate position for rotation, and when raising the hand above the head, shoulder impingement occurs.

To understand the importance of the above, sit on a chair in a proper body position and raise your hand. In this case, there is a full range of motion and very little pain will be felt. Now lean forward and raise your hand. In this case, the range of motion will decrease and the feeling of being trapped in the shoulder will be felt; Because there has been a change in the condition of the scapula.

How Do We Avoid Strains and Sprains?

Effective factors in shoulder impingement syndrome

Shoulder impingement syndrome usually indicates wear and tear. This complication is more common in people who frequently raise their hands above their heads while performing activities. Various sports activities are also effective in the occurrence of this condition. Shoulder impingement syndrome is more common in the following occupations and sports:

  • Building Painter
  • Auto Mechanic
  • swimmers
  • tennis players
  • Bodybuilders and weightlifters
  • Volleyball players
  • Badminton players
  • Handball players

The above exercises should be avoided until the pain is relieved.

Symptoms of Shoulder Impingement Syndrome

Usually, the symptoms of this syndrome are mild at first and gradually worsen. In the early stages, due to the cessation of activities, the pain will be resolved after a day. Of course, with the progress of the syndrome, this condition becomes chronic, and raising the hand even during simple activities can cause pain. Symptoms of shoulder impingement syndrome include:

  • shoulder pain that occurs both during rest and activity; Especially when raising the hand above the level of the shoulders. The pain usually occurs suddenly when lifting objects and raising the hand, and sometimes the pain spreads from the front of the shoulder to the side of the arm.
  • Mild to moderate weakness that worsens with raising the arm.
  • Inflammation and feeling of pain when touching the front of the shoulder (shoulder inflammation)
  • Hearing a sound in the joint when moving the shoulder
  • Numbness or tingling in the hands
  • Difficulty finding a comfortable position to sleep

Diagnosis of Shoulder Impingement Syndrome

Various methods are used to diagnose shoulder impingement. The physiotherapist uses several tests to diagnose the cause and location of the impingement. It is possible to use MRI for this purpose, but it is not necessary to use this method by a physiotherapist to diagnose shoulder impingement syndrome. X-ray imaging helps show the acromion’s bony types and observe the reduction of the subacromial space.

Treatment of Shoulder Impingement Syndrome

The shoulder impingement syndrome rehabilitation program aims to reduce pain and inflammation, improve or maintain shoulder mobility, strengthen weak muscles, and improve posture-related problems.

  • Cold Therapy/ Use of ice

Using ice or cold therapy and applying compression tapes to the painful area for 10 to 15 minutes every hour helps to reduce the symptoms of this condition. Finally, the number of times using this method should be reduced to 3 to 4 times a day.

Ice should be wrapped in a towel to prevent skin damage.

  • Rest

Any activity or movement that causes pain should be avoided. Pain indicates the exacerbation of inflammation and delay in the healing process.

To maintain physical fitness, you can use a stationary bike. The period of rest and use of ice and anti-inflammatory drugs should continue for a week.

  • Taking Medication

The doctor can prescribe non-steroidal anti-inflammatory drugs such as ibuprofen. Athletes with asthma should not use ibuprofen. Taking medicine during the initial period of rehabilitation (during the first few days) helps to improve the condition, but using more than this period does not affect recovery.

  • The Effect of Physiotherapy in the Treatment of Shoulder Impingement Syndrome

Early treatment immediately after the onset of shoulder impingement syndrome is very important. As a result of this syndrome, other complications such as bursitis, rupture or rotator cuff tendon inflammation may occur.

Physiotherapy has a significant effect on the treatment of shoulder impingement syndrome. The physiotherapist works with the patient to plan a unique treatment plan. The treatment plan includes:

  • Manual Therapy: 

the physiotherapist can use manual therapy techniques such as gentle movements in the joints, soft tissue massage (massage therapy), and stretching exercises to improve mobility and relieve shoulder impingement.

  • Electrotherapy:

     The physiotherapist may use electrotherapy methods such as ultrasound to reduce pain and inflammation. In this method, high-frequency sound waves are transferred to the target tissue.

  • Exercises Related to Increasing the Range of Motion:

These exercises and stretching movements help the correct shoulder and scapula bone movement, and the patient can continue his daily activities without pain.

  • Strengthening Exercises:

     The physiotherapist determines the strengthening exercises suitable for the patient. Due to the occurrence of shoulder impingement syndrome, due to the weakening of the rotator cuff muscles, the head of the humerus usually moves forward and up. Strengthening the muscles of the rotator cuff and the scapula helps to improve the position of the head of the humerus and eliminate shoulder impingement. Resistance exercises may also be used to strengthen muscles. After completing the physiotherapy program, the home exercise program is used to continue supporting the muscles.

  • Patient Education:

     Learning the correct posture is an essential part of the rehabilitation process. For example, when the shoulders are bent forward, the tendons in the front of the shoulder can get stuck. The physiotherapist cooperates with the patient to improve the physical condition and provides the necessary advice to the patient about making changes in the work environment. The patient also learns the essential things related to different body positions for sleeping and using the right pillow to prevent pain while sleeping.

  • Functional Exercises:

     As symptoms improve, the physical therapist teaches the patient how to perform functional exercises (such as lifting and placing an object on a rack or throwing a ball) using correct shoulder mechanics. This exercise helps relieve pain at work, at home, and during sports activities.

  • Using a Stretch Band:

     Kinesio stretching tape can be used to increase the mobility of the rotator cuff muscles to improve shoulder stability. This type of band helps to prevent the hypertonic muscles (tight and contracted) that are effective in the occurrence of poor posture.

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