Irritated by Impingement Syndrome?
It came on suddenly and stayed for over a year.
It was a gift I didn't ask for and at times it was damn irritating and painful.
So many movements hurt: fastening my seat belt, putting on my coat, reaching to the side to turn off a lamp and many more.
All the symptoms of a rotator cuff injury, right? Well, those muscles weren't particularly tender.
Perhaps because I had written a book on the subject, I was certain that my problem had to be with one of those four miraculous muscles.
Finally after a frustrating month, I gave up trying to self-diagnose, (is anybody else guilty of that?), and went to a chiropractor who is also a physical therapist.
He immediately did the test for impingement syndrome and of course, it was positive.
I remember saying to him, "Oh yeah, I forgot about that!" Impingement syndrome shares many of the same symptoms as a rotator cuff dysfunction and it's sometimes hard to tell the difference.
They cause pain in the upper arm, decrease range of movement and have you running for your favorite over the counter pain reliever.
The rotator cuff is involved in impingement syndrome in that the cuff is intimately involved with healthy shoulder mechanics.
But, having had this myself and working on hundreds of shoulders, it is possible to have a fairly happy rotator cuff and still suffer with impingement syndrome.
Let's review the anatomy.
The superior aspect of the shoulder joint is called the impingement area.
The primary structures affected in Shoulder Impingement Syndrome are the supraspinatus tendon, the sub-acromial bursa and the long head of the biceps.
When the humerus is internally rotated, the greater tubercle rolls forward, taking that supraspinatus tendon along for the ride.
Since the supraspinatus attaches to the top of the greater tubercle, it will collide with the acromion process if the humerus is abducted in the internally rotated position.
Try internally rotating and abducting your humerus and you'll feel the restriction of the greater tubercle colliding with the acromion process.
Just imagine how many times people do this on any given day! You can see why this muscle/tendon unit is so frequently torn and/or impinged.
The subacromial bursa lies above the supraspinatus and underneath the acromion process and, of course, it too suffers from irritation and inflammation when impinged.
Let's turn our attention to the long head of the biceps.
Habitual internal rotation will cause that tendon to rub against either the lessor or greater tubercles causing micro-tearing, impingement, and inflammation.
If you suspect impingement syndrome, you can test for it easily.
Flex the client's shoulder to 90 degrees and from that position, internally rotate and horizontally adduct, (bring the arm across the chest), the humerus as far as it will go.
This brings the greater tuberosity of the humerus up under the coracoacromial arch and it will press on the soft tissue structures under the arch (supraspinatus tendon, long head of biceps and subacromial bursa.
) If impingement syndrome is present, this test will reproduce the pain/discomfort.
If you have a client that is not responding to treatment, they may have a Type II or Type III acromion process.
In Type II, the acromion process is curved and dips downward; Type III acromion processes are beaked.
Both types obstruct the outlet for the supraspinatus tendon.
This can easily be seen with an X-Ray.
Surgery may be the best option, especially for Type III's.
My personal experience with impingement syndrome is that it responds well to ultra sound, acupuncture, good, precise deep tissue work on the rotator cuff, serratus anterior, trapezius (especially where it attaches to the clavicle and acromion), pectoralis major and minor, along with ice, stretching and the pendulum exercise (see below).
PENDULUM EXERCISE: An excellent, gentle, releasing exercise for the shoulder joint is to come into a lunge position and allow the affected arm to hang down toward the floor.
Circle that arm (imagine drawing small circles on the floor with your fingers) clockwise then counterclockwise.
Even better is to use a hand weight, anywhere from five to ten pounds.
This tractions the head of the humerus which tends to get jammed up in the joint.
It was a gift I didn't ask for and at times it was damn irritating and painful.
So many movements hurt: fastening my seat belt, putting on my coat, reaching to the side to turn off a lamp and many more.
All the symptoms of a rotator cuff injury, right? Well, those muscles weren't particularly tender.
Perhaps because I had written a book on the subject, I was certain that my problem had to be with one of those four miraculous muscles.
Finally after a frustrating month, I gave up trying to self-diagnose, (is anybody else guilty of that?), and went to a chiropractor who is also a physical therapist.
He immediately did the test for impingement syndrome and of course, it was positive.
I remember saying to him, "Oh yeah, I forgot about that!" Impingement syndrome shares many of the same symptoms as a rotator cuff dysfunction and it's sometimes hard to tell the difference.
They cause pain in the upper arm, decrease range of movement and have you running for your favorite over the counter pain reliever.
The rotator cuff is involved in impingement syndrome in that the cuff is intimately involved with healthy shoulder mechanics.
But, having had this myself and working on hundreds of shoulders, it is possible to have a fairly happy rotator cuff and still suffer with impingement syndrome.
Let's review the anatomy.
The superior aspect of the shoulder joint is called the impingement area.
The primary structures affected in Shoulder Impingement Syndrome are the supraspinatus tendon, the sub-acromial bursa and the long head of the biceps.
When the humerus is internally rotated, the greater tubercle rolls forward, taking that supraspinatus tendon along for the ride.
Since the supraspinatus attaches to the top of the greater tubercle, it will collide with the acromion process if the humerus is abducted in the internally rotated position.
Try internally rotating and abducting your humerus and you'll feel the restriction of the greater tubercle colliding with the acromion process.
Just imagine how many times people do this on any given day! You can see why this muscle/tendon unit is so frequently torn and/or impinged.
The subacromial bursa lies above the supraspinatus and underneath the acromion process and, of course, it too suffers from irritation and inflammation when impinged.
Let's turn our attention to the long head of the biceps.
Habitual internal rotation will cause that tendon to rub against either the lessor or greater tubercles causing micro-tearing, impingement, and inflammation.
If you suspect impingement syndrome, you can test for it easily.
Flex the client's shoulder to 90 degrees and from that position, internally rotate and horizontally adduct, (bring the arm across the chest), the humerus as far as it will go.
This brings the greater tuberosity of the humerus up under the coracoacromial arch and it will press on the soft tissue structures under the arch (supraspinatus tendon, long head of biceps and subacromial bursa.
) If impingement syndrome is present, this test will reproduce the pain/discomfort.
If you have a client that is not responding to treatment, they may have a Type II or Type III acromion process.
In Type II, the acromion process is curved and dips downward; Type III acromion processes are beaked.
Both types obstruct the outlet for the supraspinatus tendon.
This can easily be seen with an X-Ray.
Surgery may be the best option, especially for Type III's.
My personal experience with impingement syndrome is that it responds well to ultra sound, acupuncture, good, precise deep tissue work on the rotator cuff, serratus anterior, trapezius (especially where it attaches to the clavicle and acromion), pectoralis major and minor, along with ice, stretching and the pendulum exercise (see below).
PENDULUM EXERCISE: An excellent, gentle, releasing exercise for the shoulder joint is to come into a lunge position and allow the affected arm to hang down toward the floor.
Circle that arm (imagine drawing small circles on the floor with your fingers) clockwise then counterclockwise.
Even better is to use a hand weight, anywhere from five to ten pounds.
This tractions the head of the humerus which tends to get jammed up in the joint.