Impingement Syndrome Shoulder
Mechanical compression and irritation of the soft tissues ( rotator cuff and subacromial bursa) in the suprahumeral space is called impingement syndrome, and the most common cause of shoulder pain.
is the result of intrinsic or extrinsic factors that encroach against the tissue in the subacromial space. Intrinsic factors are usually relate to trophic changes in the choracoacromial arch or the joint space, which decrease the suprahumeral space. Extrinsic factors that result in decreased suprahumeral space and rpetitive trauma to the soft tissues during elevation of the arm include posterior capsular tightness, poor neuromuscular control of the rotator cuff or scapular muscles, faulty scapulothoracic posture or a partial or compelet tear of the tissues in the suprahumeral space ( either from trauma or degenerative situations). Neer.
is used to describe symptoms from faulty mechanics that occur from hyper mobility or instability of the GH joint with increased translation of the humeral head. The instability may be unidirectional or multi directional.
Unidirectional instability usually occurs from trauma and results in partial tearing of some the supporting ligaments or glenoid labrum, but may occur from a lax capsular tissues. Hyper mobility can cause other problem beside impingement such as subluxation, dislocation or rotator cuff tendinitis, which with macro trauma can lead to degenrative changes such as bone spurs, tendon rupture or capsular restrictions and frozen shoulder.
Tendinitis at the shoulder is common. it occurs in young active persons as well as in older persons, and about equally in males and females. In the case of a younger person it may be caused by activities such as tennis, racquetball. Or baseball, which increase the stress levels to the rotator cuff tendons. In the older person it is more likely to be a degenerative lesion. Because of the relatively poor blood supply near the insertion of the supraspinatus, nutrition to the area may not meet the metabolic demands of the tendon tissue. The resultant focal cell death sets up an inflammatory response, probably due to the release of irritating enzymes and dead tissue acting as foreign body. The body may react by laying sown scar tissue or calcific deposits. Such calcific deposits may be visible on radiography: however, they are often seen in the absence of symptoms and , conversely, they are not always present in known cases of tendinitis. Superficial migration of their deposits with rupture in the under side of the sub deltoid bursa is thought to be a major cause of acute bursitis at the shoulder. Because of the poor blood supply to the region, adequate repair may not occur, and the lesion may develop into an actual tear in the tendon.
the lesion is usually near the musculotendinous junction and result in a painful arc with overhead reaching. Pain occurs with the impingement test ( forced humeral elevation in the plane of the scapula while the scapula is passively stabilized so that the greater tuberosity impacts against the acromion. Or with the arm in internal rotation while flexing the humerus). There is pain on palpation of the tendon just inferior to the anterior aspect of the acromion when the patient’s hand is placed behind the back. It is difficult to differentiate partial tear from subdeltoid bursitis because of the anatomic proximity.
the lesion is usually near the musculotendinous junction and results in a painful arc with over head or forward motions. It may present as deceleration (eccentric) injury from overload during repetitive or forceful throwing activities. Pain occurs on palpation of the tendon just inferior to the posterior corner of the acromion when the patient horizontally adducts and laterally rotates the humerus.
the lesion involves the long tendon in the bicipital groove beneath or just distal to the transverse humeral ligament. Swelling in the bony groove is restrictive and compounds and perpetuates the problem. Pain occurs with resistance to the forearm in a supinated position while the shoulder is flexing(speed’s sign) and on palpation of the bicipital groove. A rupture or dislocation of this humeral depressor may escalate impingement of tissues in the suprahumeral space.
transverse friction massage is an essential component of the treatment program in chronic cases. The beneficial effects of the friction massage in such cases are not well understood, However, it is proposed that an increase int eh mobility of the developing , or developed scar tissue occurs without stressing the tendon longitudinally. This prevents the healing tissue from being continually re torn during daily activities.
Friction Massage: Friction massage is indicated for chronic conditions often soft tissues- usually tendons, ligaments, or muscles arising from abnormal modeling of fibrous elements in respond to fatigued stresses or accompanying resolution of an acute inflammatory disorder.( supraspinatus tendon: light to deep transverse friction massage is given over the tendon.)