SHOULDER IMPINGEMENT

doi:10.1016/S0030-5898(05)70148-6

Orthopedic Clinics of North America

Volume 31, Issue 2, 1 April 2000, Pages 285-293

https://doi.org/10.1016/S0030-5898(05)70148-6 Get rights and content

Subacromial impingement with rotator cuff tendinitis is probably the commonest shoulder condition seen by the orthopedic surgeon. If left untreated or misdiagnosed, partial-thickness and full-thickness rotator cuff tears may result. The impingement process can be caused by several mechanisms. The cause can range from mechanical factors to glenohumeral instability. Understanding the pathophysiology and the treatment of this disorder is the keystone to understanding all other aspects of shoulder rehabilitation.

Impingement rehabilitation focuses on strengthening the humeral head depressors, while ignoring the deltoid and supraspinatus muscles. Later treatment includes specific retraining of scapular balancing muscles. The final phase of treatment includes strengthening of the prime humeral movers in positions that avoid further stress to the previously injured rotator cuff tendons and, last of all, specifically strengthening the supraspinatus muscle.

Section snippets

ANATOMY

There are several theories as to the exact cause of subacromial impingement syndrome and rotator cuff tendinitis. These two terms are not interchangeable. Impingement syndrome refers to a specific pathologic condition in which there is irritation of the supraspinatus tendon secondary to abrasion against the undersurface of the anterior one third of the acromion. Rotator cuff tendinitis, which encompasses impingement, also may be a result of acute rotator cuff overload, intrinsic rotator cuff

THERAPEUTIC CONSIDERATIONS

Proper individualized shoulder rehabilitation enhances the nonoperative and operative treatment of shoulder impingement. Rehabilitation should begin as early as possible after injury or surgery. Initial therapy should assist rather than retard soft tissue healing. This therapy speeds the return to activity and shortens the period of disability. Rotator cuff rehabilitation should be conducted in a manner that promotes normal scapulohumeral rhythm. This rehabilitation should include synchronicity

THERAPY AND REHABILITATION

Various rehabilitation approaches have been suggested for conservative management of impingement syndrome and rotator cuff tendinitis. Past attempts at rehabilitation have placed considerable emphasis on isolation of the supraspinatus muscle. Review of biomechanical function of this highly studied muscle reveals that it primarily acts in concert with the deltoid as a humeral elevator and secondarily assists with compression and stabilization of the humeral head in the glenoid fossa. With this

CLINICAL APPLICATION

Rehabilitation of impingement syndrome should be conducted in a systematic fashion. It can be divided into three areas of concentration: decreasing inflammation, soft tissue stretching, and strengthening. Following is a synopsis of the authors' nonoperative management of rotator cuff syndrome.

External Anatomic Impingement

There are several causes of external anatomic impingement, including instability, acromial morphology, and anatomic abnormalities. A concerted effort must be made to delineate the exact cause before beginning a rehabilitation program. If the primary problem is an anatomic abnormality, such as an acromioclavicular separation with a drooping scapula, a reconstruction of the ligaments, such as a Weaver-Dunn procedure or modification thereof, is in order. Fractures of the greater tuberosity or

EXERCISE EQUIPMENT MODIFICATIONS

A systemic approach toward weight training is needed when establishing guidelines for the home program. Surgeons and therapists should become familiar with the various types of equipment available in local health clubs. This familiarity enables them to provide guidelines on equipment selection and exercise modification, in an effort to prevent further shoulder injury because of improper use.

Various exercise machines are designed for increasing deltoid strength, but they place the rotator cuff

SUMMARY

Most patients who come to the authors' office having undergone previous shoulder rehabilitation have not experienced a therapeutic benefit. Most, however, have been treated with a suboptimal program. Hot packs, massage, and ultrasound, rarely produce results. The authors rarely see a patient who understands the cause of the shoulder pain and know the goals of the rehabilitation program. These are the most basic requirements for a successful program. The protocol outlined in this article is

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Relationship between acromial morphology and rotator cuff tears
Orthop Trans
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Rehabilitation of the shoulder
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Anterior shoulder instability, impingement and rotator cuff tear: Theories and concepts
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There are more references available in the full text version of this article.

Cited by (72)

Comparison of the efficacy of manual treatment according to fascial distortion model versus joint mobilization in patients with shoulder impingement: A randomized clinical trial
2023, Journal of Bodywork and Movement Therapies
The Fascial Distortion Model (FDM) is a relatively new manual therapy approach in the field of musculoskeletal physical therapy, but to date no study has been conducted to compare its’ effect in comparison with joint mobilization on patients with shoulder impingement syndrome.
The present study aims to compare the efficacy of the FDM versus joint mobilization in pain intensity, pain-free abduction range of motion and function of patients with shoulder impingement syndrome.
single-blind, parallel-arm randomized controlled trial.
26 patients diagnosed with shoulder impingement syndrome were equally randomized into 2 groups: manual treatment according to the FDM, and joint mobilization of the shoulder complex. All patients received 3 intervention sessions every other day. Pain intensity (by visual analogue scale), pain-free abduction range of motion (by goniometry) and function (by Persian version of shoulder pain and disability index) were measured before and after every session and at follow-up 2 weeks later. Patients’ satisfaction with treatment was also measured (by a 4-point Likert scale) at follow-up.
FDM therapy group showed statistically significant greater pain reduction (P = 0.014) and range of motion increment (P = 0.044) than joint mobilization group after intervention, while only range of motion maintained the difference at follow-up (P = 0.034). Function improvement was not statistically different after the intervention (P = 0.582) and at follow-up (P = 0.094). There was no difference in patients’ satisfaction with treatment between groups (P > 0.05).
The FDM is a safe and effective treatment approach with comparable results to joint mobilization in patients with shoulder impingement syndrome.
Struck down in the marketplace: Bioarchaeological analysis of an individual recovered from the earthquake complex at Kourion
2021, Journal of Archaeological Science: Reports
Citation Excerpt :
The rotator cuff is made up soft tissue attachments for the subscapularis, supraspinatus, infraspinatus, and teres minor muscles (Lee and Lang, 2000). There are significant difficulties in identifying rotator cuff disease (a primarily soft tissue injury) with only hard tissue to examine (Rothschild, 2019), so caution must be exercised in the specific identification of any such injury, but typically impingement of the shoulder tends to be associated with functional overload of the joint through repeated use of the shoulders in lifting or throwing motions (Morrison et al., 2000) Here, only the presence of new bone addition is noted with the possible association with rotator cuff impingement of the supraspinatus tendon.
This article details the excavation and osteobiography of a single individual from the Earthquake Complex at the late Roman site of Kourion on the island of Cyprus. The Earthquake Complex consists of two structures, the Earthquake House and Market Building, that were damaged and then destroyed by a series of earthquakes in the fourth century CE. Originally found in 1987 during excavations of the Earthquake Complex, this individual was excavated en bloc and removed to the Episkopi museum. Continued excavations of the individual and osteological analysis were completed in 2015. Detailed here are the recovery and reconstruction of events surrounding the individual’s death. This individual died during one of the fourth century CE earthquakes that affected life throughout the eastern Mediterranean. Kourion suffered multiple earthquakes in this time frame; this snapshot archaeological deposit provides an opportunity to understand a single individual’s experience within this destructive episode.
Comparison of different electrotherapy methods and exercise therapy in shoulder impingement syndrome: A prospective randomized controlled trial
2018, Acta Orthopaedica et Traumatologica Turcica
The aim of this study was to assess and compare the effects of different electrotherapy methods and exercise therapy on pain, function and quality of life in shoulder impingement syndrome.
Eighty-three patients (66 females, 17 males; mean age: 48.2 ± 7.33 years) with shoulder impingement syndrome were selected and 79 of them were randomly allocated into four groups. Group 1 (n = 19, mean age: 47.89 ± 7.12 years) was given hot pack and exercises, Group 2 (n = 20, mean age: 47.70 ± 6.51 years) was given hot packs, exercises and interferential current, Group 3 (n = 20, mean age: 48.50 ± 8.34 years) was given hot packs, exercises and TENS and Group 4 (n = 20, mean age: 48.55 ± 7.89 years) was given hot packs, exercises and ultrasound three times a week for four weeks. Assessments were made before treatment, right after it and three months after that using the visual analog scale (VAS), Short Form-36 (SF-36) and the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measures.
At the fourth week and third month assessments, all groups showed significant improvements in terms of pain, DASH and SF-36 physical component scores (p < 0.05). In intragroup comparisons, a significant difference between pre- and post-treatment results was found only in SF-36 mental component scores of Group 2. No significant difference was observed between the groups in any stage of the study period (p > 0.05).
Application of ultrasound, interferential current and TENS in addition to exercise therapy in shoulder impingement syndrome treatment had similar improvements in terms of pain, function and physical component of quality of life. However, interferential current treatment showed significantly better outcomes for the mental component of quality of life.
Level I, Therapeutic study.
Impingement Syndrome
2017, Clinical Orthopaedic Rehabilitation: A Team Approach, Fourth Edition
Ultrasonography of Subcoracoid Bursal Impingement Syndrome
2015, PM and R
Subcoracoid impingement syndrome with bursitis is an underrecognized cause of anterior shoulder pain. It usually presents with pain around the coracoid process and a positive impingement test with shoulder adduction, forward flexion, and internal rotation. The pain is mediated by impingement of soft tissues such as the subcoracoid bursa or subscapularis tendon between the coracoid process and humerus. Ultrasonography (US) can be useful in the evaluation of subcoracoid bursal impingement syndrome because of its high resolution capacity and the use of dynamic maneuvers. In this case series, we present 3 patients with subcoracoid impingement syndrome with bursitis diagnosed with in-office US. This case series illustrates the application of US in the evaluation of anterior shoulder pain with subcoracoid bursal impingement syndrome.
Glyceryl trinitrate patches-An alternative treatment for shoulder impingement syndrome
2015, Journal of Orthopaedic Translation
Citation Excerpt :
The administrating dosage can be titrated simply to facilitate the treatment intention, in the context of the clinical trials below a 5 mg/24-hour patch is subdivided into equal quarterly 1.25 mg/24-hour patches, replaced daily [14]. The presentation of shoulder impingement is often concurrent to rotator cuff tendinitis, and may progress to chronic inflammation or tendinopathy if it remains untreated [17]. Thus, a mainstay of treatment involves restoring rotator cuff function [18].
Transdermal glyceryl trinitrate patches have been investigated as an alternative therapeutic intervention for a range of tendinopathies, due to the ease of titration of dosage and the ease of their application. Glyceryl trinitrate has been inferred to reduce pain and inflammation secondary to their nitric oxide-producing action. Shoulder impingement syndrome is a soft tissue condition that manifests as anterior shoulder pain, weakness, and difficulty in daily activities. This review will evaluate the efficacy of glyceryl trinitrate patches in treating a variety of rotator cuff tendinopathies related to shoulder impingement, based on human and animal trials, and suggest its practical application in future trials and management.

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: Address reprint requests to David S. Morrison, MD, Southern California Center for Sports Medicine, 2760 Atlantic Avenue, Long Beach, CA 90806

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SHOULDER IMPINGEMENT

Section snippets

ANATOMY

THERAPEUTIC CONSIDERATIONS

THERAPY AND REHABILITATION

CLINICAL APPLICATION

External Anatomic Impingement

EXERCISE EQUIPMENT MODIFICATIONS

SUMMARY

Relationship between acromial morphology and rotator cuff tears

Orthop Trans

Rehabilitation of the shoulder

Anterior shoulder instability, impingement and rotator cuff tear: Theories and concepts

The role of the scapula in athletic shoulder function

Am J Sports Med