Physical therapy treatment of Shoulder impingement syndrome

Definition

Shoulder impingement syndrome describes a condition wherein the tendons of the rotator cuff of the shoulder are pinched as they pass between the pinnacle of the upper arm (humerus) and the end of the shoulder (acromion). The rotator cuff is a set of four muscles i.e. subscapularis, teres minor, supraspinatus and infraspinatus. It causes narrowing of the sub acromial bursa.

Painful Arc

Painful arc is initiated when the arm is abducted in anatomical plane in such a manner that the glenohumeral joint glides downwards. In the painful arc if the pain occurs between 60 degrees to 120 degrees it is due to sub acromial shoulder impingement. The gliding doesn’t occur properly. Major structures like supraspinatus tendon and the coracoid ligaments are squeezed between greater tubercle and acromion.

Clinical presentation

• Shoulder Pain
• Increased Laxity — usually anterior laxity seen
• Popping or clicking sound
• Rotator cuff weakness
• Muscle asymmetry — Both limbs are examined to see the difference

Diagnostic test

Drop arm test- Impingement / Supraspinatus tear (Rotator cuff tear)

The patient is told to actively elevate the arm accompanied by way of slowly reversing the motion. The arm suddenly drops all at once or the patient reviews ache.

Neer sign — Subacromial impingement

The therapist have to stabilize the affected person’s scapula with one hand, while passively flexing the arm at the same time ask him to turned around internally. If the affected person reviews pain on this position, then the result of the test is taken into consideration to be positive.

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