top of page

July 26th, 2022: Dr. Noah Aksu

2.png


SHOULDER


Impingement


syndrome
 

Whether you sit in front of a desk for hours or out in the sun doing labour work all day, you are prone to shoulder pain. Shoulder issues affect the daily life activities of many! It may range from constant aching/ nagging pain, to sudden sharp stabbing sensation during specific movements. Read on the find out the causes and what YOU can do to avoid and/ or relieve your shoulder pain. 

1.png

Shoulder impingement syndrome results from a vicious cycle of rubbing the rotator cuff muscles between your humerus and the top outer edge of your shoulder. The rubbing leads to more swelling and further narrowing of the space, which results in pain and irritation. The Rotator cuff muscles consist of four smaller muscles; supraspinatus, infrspinatus, subscapularis and teres minor. These four muscles work together to allow proper shoulder movement and function. Trauma such as falling onto an outstretched arm or as simple as lifting barbells at the gym, may cause one of these muscles to become pinched inflamed. 

What is SHOULDER impingement syndrome?

Untitled design (3).png

Sciatica 
COMMON CAUSES

Primary impingement

  • Increased subacromial loading

  • Acromial morphology (A hooked acromion, presence of an os acromiale or osteophyte, and calcific deposits in the subacromial space make patients more predisposed to primary impingement.)

  • Acromioclavicular arthrosis (inferior osteophytes)

  • Coracoacromial ligament hypertrophy

  • Coracoid impingement

  • Subacromial bursal thickening and fibrosis

  • Prominent humeral greater tuberosity

  • Trauma (direct microtrauma or repetitive microtrauma)

  • Overhead activity (athletic and nonathletic

Secondary impingement

  • Rotator cuff overload/soft tissue imbalance

  • Eccentric muscle overload

  • Glenohumeral laxity/instability

  • Long head of the biceps tendon laxity/weakness

  • Glenoid labral lesions

  • Muscle imbalance

  • Scapular dyskinesia

  • Posterior capsular tightness

  • Trapezius paralysis

USE8_edited.jpg

The three stages of Shoulder impingement syndrome?

The three stages of shoulder impingement syndrome

  • Stage 1: commonly affecting patients younger than 25 years, is depicted by acute inflammation, edema, and hemorrhage in the rotator cuff. This stage usually is reversible with nonoperative treatment.

  • Stage 2: usually affects patients aged 25-40 years, resulting as a continuum of stage 1. The rotator cuff tendon progresses to fibrosis and tendonitis.

  • Stage 3: commonly affects patients older than 40 years. As this condition progresses, it may lead to mechanical disruption of the rotator cuff tendon and changes in the coracoacromial arch with osteophytosis along the anterior acromion.

How can Chiropractic care help?

The diagnosis of shoulder impingement syndrome will involve the doctor doing a physical examination, palpation, orthopaedic tests, muscle tests, range of motion assessment, functional tests, neurovascular exam, and diagnostic imaging such as an ultrasound.

​

Once the acute pain starts to recede and mobility and function return, our team will ensure the continuing care to prevent another such injury in the goal to improve your overall long term musculoskeletal health.

 

Your chiropractor will assist in:

  • Carefully and accurately diagnose your condition

  • Perform soft or deep tissue massage to alleviate muscular tension and pain

  • Implement spinal manipulative techniques to enforce joint movement and ease disc-related symptoms

  • Prescribe stretches and rehabilitative exercises

  • Recommend advice and lifestyle changes

 

Treatment options for shoulder impingement syndrome?

Conservative and physical therapy such as Chiropractic therapy is the first line of treatment for shoulder impingement syndrome. This will result in the reduction of pain and inflammation alongside restoring your range of motion. The Chiropractor will also provide the patient with the necessary rehab to aid in the process and provide a longer-lasting effect of relief. Other forms of treatment include subacromial injections, analgesic and anti-inflammatory medication, high-intensity laser, and lastly, surgical interventions.

  •  

Sources

    • Neer CS 2nd. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am. 1972 Jan. 54(1):41-50.

    •  

    • Bigliani LU, Morrison DS, April EW. The morphology of the acromion and rotator cuff: importance. Orthopedic Trans. 1986. 10:228.

    •  

    • Alqunaee M, Galvin R, Fahey T. Diagnostic accuracy of clinical tests for subacromial impingement syndrome: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2012 Feb. 93(2):229-36.

    •  

    • Steuri R, Sattelmayer M, Elsig S, Kolly C, Tal A, Taeymans J, et al. Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs. Br J Sports Med. 2017 Sep. 51 (18):1340-1347.

    •  

    • Hallgren HC, Holmgren T, Oberg B, Johansson K, Adolfsson LE. A specific exercise strategy reduced the need for surgery in subacromial pain patients. Br J Sports Med. 2014 Oct. 48 (19):1431-6.

    •  

    • Santamato A, Panza F, Notarnicola A, et al. Is Extracorporeal Shockwave Therapy Combined With Isokinetic Exercise More Effective Than Extracorporeal Shockwave Therapy Alone for Subacromial Impingement Syndrome? A Randomized Clinical Trial. J Orthop Sports Phys Ther. 2016 Sep. 46 (9):714-25.

    •  

    • Keenan KA, Akins JS, Varnell M, et al. Kinesiology taping does not alter shoulder strength, shoulder proprioception, or scapular kinematics in healthy, physically active subjects and subjects with Subacromial Impingement Syndrome. Phys Ther Sport. 2016 Jun 19.

    •  

    • Dogu B, Yucel SD, Sag SY, Bankaoglu M, Kuran B. Blind or Ultrasound-Guided Corticosteroid Injections and Short-Term Response in Subacromial Impingement Syndrome: A Randomized, Double-Blind, Prospective Study. Am J Phys Med Rehabil. 2012 May 2.

    •  

    • Moraes VY, Lenza M, Tamaoki MJ, Faloppa F, Belloti JC. Platelet-rich therapies for musculoskeletal soft tissue injuries. Cochrane Database Syst Rev. 2014 Apr 29. 4:CD010071.

    •  

    • Santamato A, Solfrizzi V, Panza F, et al. Short-term effects of high-intensity laser therapy versus ultrasound therapy in the treatment of people with subacromial impingement syndrome: a randomized clinical trial. Phys Ther. 2009 Jul. 89(7):643-52.

    •  

    • Dorrestijn O, Stevens M, Winters JC, van der Meer K, Diercks RL. Conservative or surgical treatment for subacromial impingement syndrome? A systematic review. J Shoulder Elbow Surg. 2009 Jul-Aug. 18(4):652-60.

    •  

    • Ketola S, Lehtinen J, Arnala I, et al. Does arthroscopic acromioplasty provide any additional value in the treatment of shoulder impingement syndrome?: a two-year randomised controlled trial. J Bone Joint Surg Br. 2009 Oct. 91(10):1326-34.

    •  

    • Donigan JA, Wolf BR. Arthroscopic subacromial decompression: acromioplasty versus bursectomy alone--does it really matter? A systematic review. Iowa Orthop J. 2011. 31:121-6.

    •  

    • Paavola M, Malmivaara A, Taimela S, Kanto K, Inkinen J, Kalske J, et al. Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial. BMJ. 2018 Jul 19. 362:k2860.

bottom of page