Impingement Syndrome

My shoulder won't stop hurting! I don't remember hurting my shoulder? Why can't I move my shoulder like I use to? These may be some of the thoughts that are flying through your mind. One of the most common injuries to the shoulder is to your rotator cuff (RC). What is your rotator cuff? No it is not one big muscle in your shoulder. Your rotator cuff is a group of four small but major muscles or better known as the SITS muscles. The muscles are as follows S=Supraspinatus, I=Infraspinatus, T=Teres Minor, S= Subscapularis. The tendons of these muscles make up a cuff that forms on the end of your arm bone (humerus). These muscles are small muscles in your shoulder that you tend to forget to strengthen when you are in the gym, therefore, the other shoulder muscles will over-power the rotator cuff muscles and may cause injury. The primary function of the rotator cuff muscles are internal and external rotation. Activities that may use these functions are throwing, swimming, any overhead work, racquet sports, just to name a few.

An injury to the rotator cuff can involve any type of irritation or damage to your rotator cuff muscles or tendons. There are generally three types of injuries that can be found in the RC. Tendinitis- The tendons in your RC can become inflamed or damaged for several reasons. These include repetitive stress on your rotator cuff or the development of calcium deposits within the cuff. The tendons can also be pinched under some of your shoulder bones due to bone spurs and/or inflammation. This is called impingement syndrome. Bursitis- The fluid filled sacs (bursa) located between your shoulder blade and the rotator cuff tendons can become irritated and inflamed. Strain or tear- Left untreated, tendinitis can weaken a tendon and lead to a tear in the tendon. Stress on the cuff from overuse or a fall can also cause a tendon or muscle to tear. Remember that as you age your chances for rotator cuff injuries increase. Do yourself a favor and don't ignore your shoulder pain.

If you have any of these symptoms and/or have questions about rotator cuff injuries, then stop by RehabWorks. We will be able to give you more specific information about rotator cuff injuries and if needed we will help you care for your rotator cuff injuries.

Impingement--Part II

How Do I Treat My Shoulder Injury?

The primary reason for shoulder pain is the inflammation that affects the tendons and bursa sacs. Decreasing the inflammation is the first goal of the conservative treatment protocol. Decreasing inflammation can be done the best through ice. The ice treatment can be applied right to the skin by way of a Zip-Loc bag filled with ice, or by using a ice cup. An ice cup can be made by filling a dixie cup with water and freezing it, then peel away the rim of the cup and massage the ice in a circular motion over the painful area. Ice should be applied for 15-20 minutes with at least an hour in between each icing. In addition to ice, moist heat can also be applied to more chronic shoulder injuries. For more serious injuries, ultrasound and electric stimulation are advanced modalities that can be performed by Certified Athletic Trainers or Physical Therapists.

Non-operative treatment is always the first step in dealing with a shoulder injury. Only after failure of conservative treatment should surgery be considered. After resting and icing your shoulder, if pain is still present then take the time to have your injury diagnosed by a orthopedic physician. This may include range of motion tests, strength testing, specially tests to determine specific structures injured, pain level analysis, and testing for weakness and instability in the joint. Physicians may choose to use X-rays to rule out other causes of shoulder pain such as bone fractures, arthritis, and other bone diseases. Through the hands on evaluation, if a physician detects a possible rotator cuff tear, an MRI (Magnetic Resonance Imaging) scan may be used to confirm the tear and/or other soft tissue disorders. All in all, by decreasing the inflammation our goal is to gain full, pain-free ROM(range of motion) in the shoulder joint. Once full pain-free ROM is obtained then it is time to progress into flexibility and strength training. It is important that these exercises do not cause further pain, irritation, and inflammation. It is often difficult to strengthen the rotator cuff without some shoulder soreness and discomfort. So remember to always work within your pain free ROM. Try the stretches and exercises below to help you start on your road to recovery.

Summary

1. Rest.
2. Ice to decrease inflammation and to speed up healing.
3. If pain remains have your doctor diagnosis your injury.
4. If needed, your may doctor refer you to your local Certified Athletic Trainer for injury specific care and rehabilitation.
5. Regain pain-free ROM
6. Increase flexibility
7. Strengthen shoulder and rotator cuff muscles.
8. Returns to your favorite activities without pain.