Physical Therapy Management Of Shoulder Impingement Syndrome

Summary of the Condition

Shoulder Impingement Syndrome (SIS) is shoulder pain that is exacerbated with overhead activities. Shoulder impingement has been classified into two main categories: structural and functional.

The subacromial space can become impinged from a narrowing of the subacromial space resulting from bony grown or soft-tissue inflammation (structural impingement), or superior migration of the humeral head caused by weak rotator cuff muscles (functional).

Overhead athletes are at greater risk of developing SIS due to the biomechanics of throwing that may cause tissues below the coracoacromial arch to be subjected to subtle microtrauma, leading to inflammation and tendinitis.

shouldermobilizations

Guide to Physical Therapy Practice and Suggested Management2

The Guide to Physical Therapy Practice provides clinicians with general treatment guidelines for a variety of diagnoses. Since SIS has several different causes, the Guide provides three main practice patterns that SIS falls under.

  • Pattern 4D: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With Connective Tissue Dysfunction
  • Pattern 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With Localized Inflammation
  • Pattern 4I: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated With Bony or Soft Tissue Surgery

Suggested management from the Guide to Physical Therapy Practice are simply addressing the problems listed in each pattern: improving ROM, decreasing pain, and improving strength of the shoulder.

Relieving Pain

Patients who present with SIS will have shoulder pain that is exacerbated with overhead activities. Pain will be the patients’ chief complaint and thus relieving pain will initially be the primary goal of physical therapy. Patients with SIS will present with a painful arc of motion (shown to the right).

This arc is from 60-120 degrees of shoulder abduction (ABD). Working outside of this painful arc is optimal. Educating the patient on avoiding this painful ROM with repetitive tasks is key to the initial stages of decreasing pain in the shoulder.

NSAIDs and Ice
Physicians may prescribe non-steroidal anti-inflammatory (NSAIDs) and/or recommend icing the shoulder to decrease inflammation and pain within the shoulder.

Joint Mobilizations
Joint mobilizations can also be utilized to address pain. Specific glenohumeral (GH) joint mobilization techniques discussed in research that have shown significant effects on pain reduction include: GH joint anterior, posterior, and inferior glides, and long-axis distraction passive accessory motions (PAM).

Read Full Article Here: http://morphopedics.wikidot.com/physical-therapy-management-of-shoulder-impingement-syndrome

Related Article: Everett Chiropractic Center Blog

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