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Sub Acromial Impingement Syndrome

Sub Acromial Impingement Syndrome

Who

Sub Acromial Impingement Syndrome or Shoulder Impingement is more common in the active population than those who are sedentary. The risk of developing Shoulder Impingement is further increased in sports men and women who are repeatedly using overhead arm movements such as tennis, swimming and throwing a ball, in sports such as cricket and basketball.

Unfortunately, this means that people who have occupations that require repetitive lifting or working above shoulder height are also at risk of developing Shoulder Impingement; for example, it is commonly seen among bricklayers, electricians and painters.

What

Shoulder Impingement can be classified into traumatic vs atraumatic, meaning it can develop from either trauma to or biomechanics (movement or posture) of the shoulder girdle. Impingement rarely occurs when the shoulder joint is working well, however, it is prominent when the rotator cuff tendons are inflamed and rub on the tissue inside the shoulder joint.

The rotator cuff consists of four muscles that surround the shoulder blade and joint, allowing movement of the shoulder as well as stabilisation during movement. If these muscles become overused and inflamed there is less available space inside the shoulder joint for the tendons to pass through. As a result, the tendons rub on the acromion of the shoulder joint. This rubbing is what causes the pain when you lift your arm above your head.

Symptoms

Symptoms of Sub Acromial Impingement include the following:

  • Pain throughout shoulder movement at shoulder height as well as at its highest point
  • Pain from the shoulder to the elbow
  • Pin point pain at the front of the shoulder
  • Pain when lying on the shoulder
  • Constant pain as the shoulder worsens
  • Muscle weakness when lifting heavy or not so heavy objects
  • Pain when doing your hair, cleaning your teeth or putting on clothes
  • Pain when driving your car

How do we diagnose it?

The main part of our diagnosis will come from questioning your symptoms and to gain an understanding of the whole picture of how your shoulder fits in to your day-to-day life relative to your presentation. From here we will complete a postural examination, which will enable us to determine if your shoulder blade or upper back or neck are contributing to your presentation. Following on from that we will do some specific tests of your shoulder joint and muscles to determine where the source of the problem is.

If we believe it is essential, we will refer you for an MRI or an ultrasound to determine the exact source of the problem. This is not relevant for everyone with shoulder pain.

Management

The most critical part of the management of Sub Acromial Impingement is to release the soft tissue surrounding the shoulder joint. From there, it is important that your neck and upper back is moving freely to allow optimal function of the shoulder. Your physio will guide you through a home exercise program as well to help maintain the gains made in treatment and extend your relief.

If your shoulder is not responding you may be recommended to get an injection into your shoulder from your doctor. This, like imaging, is in extremely rare cases.

The Physiotherapists at MTM Physiotherapy Warwick utilise the following treatments:

  • Massage
  • Joint Mobilisations
  • Dry Needling
  • Electrotherapy if relevant
  • Taping
  • Home exercise programs (strength, range of motion and scapula control)
  • Home management advice
  • Exercise rehabilitation in the Warwick Workout gym
  • Return to sport fitness testing and training on the Warwick Stadium courts

If you have any questions about your shoulder or any other ache or pain, I would love to hear from you!

Article by Matt Beavis

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