Cprx injury of the month

Shoulder pain is a common problem in our patients and with our family and friends. Some of the risk factors for shoulder pain include age, repetitive use (sports, work), our anatomy/structure, poor posture and/or shoulder mechanics, incorrect body coordination or core stabilization, or from injury or trauma. One of the common causes of shoulder pain is having a Shoulder Impingement Syndrome. Shoulder impingement syndrome is also known as Rotator Cuff impingement, Subacromial bursitis, or Rotator Cuff tendonitis. Shoulder impingement happens when one of the Rotator Cuff muscles (most commonly the Supraspinatus muscle) and/or the bursa (lubricating tissue) is pinched under the acromion when the arm is raised into a forward or upward position. Repetitive impingement can make the tendons and the bursa inflamed, resulting in pain.According to the Centers for Disease Control and Prevention (CDC), approximately 13.7 million people in the United States requested treatment for shoulder pain in 2003. They also reported that in 2006, 9% of adults in the United States had shoulder pain in the last 30 days. Do you fit into this category?



Symptoms of shoulder impingement may vary depending on if the symptoms are a result of a specific injury or traumatic event or if the gradually progress over time due to degenerative changes in the joint or as a result of a movement impairment. The most common symptoms of shoulder impingement include local swelling and tenderness in the front of your shoulder which may radiate down the side of your arm.
Pain is often worsened when raising your arm overhead and performing activities with your arm behind your back (fastening a bra, washing your back, etc). You may also experience a “catching” sensation in your shoulder when lowering your arm from an overhead position. Athletes participating in overhead sports may have pain when throwing, swimming, serving a tennis ball, volley ball etc. As your symptoms progress, you may have pain at night especially if you are lying on the affected side. If you are experiencing any of these symptoms, it would be a good idea to follow up with your primary physician or orthopedist. If left untreated, these symptoms could lead to a Rotator Cuff Tear and/or further damage to the surrounding structures.

Treatment Options

Patients are typically referred to physical therapy by their physicians for shoulder impingement or rotator cuff problems, before any surgical options are discussed. Surgery may be avoided with conservative treatments such as skilled physical therapy, however, this is not the case for all patients depending on the severity of the injury, degree of rotator cuff tear, or the type of bony structures they have. Physical therapy treatments are highly recommended after shoulder surgeries to restore normal motions and strength.

Non-surgical shoulder patients:

CPRx physical therapists are here to identify the CAUSE of the shoulder impingement / rotator cuff problems. The medical diagnoses help us learn the source of the pain (for example, irritated or torn rotator cuff, inflamed subacromial bursa, bone spur in the subacromial space). Rather than treating the shoulder with solely modalities to decrease the pain, CPRx physical therapists have the knowledge in anatomy and kinesiology to problem-solve the movement impairment that causes the impingement or rotator cuff problems. The initial evaluation includes postural assessment, movement tests, muscle length test, strength test, and functional tests to find an abnormal pattern of shoulder movements. Patients will have either a scapular or a humeral movement diagnosis, or both. Shoulder pain can result from incorrect or insufficient scapular (shoulder blade) movements, as well as abnormal humeral (top of your arm bone) movements. These movements are caused by muscle imbalance around the shoulder girdle.
For example, if the chest muscles are too stiff, and there isn’t enough strength or tension on the opposite muscles (muscles on your back near the shoulder blade), the scapula will not move correctly. When the scapula is not moving normally, this can cause shoulder impingement. Similarly, if the humerus is not spinning and gliding properly in the shoulder socket, this can also cause shoulder impingement. CPRx physical therapists are here to identify these movement problems and prescribe individualized exercises to restore normal shoulder mechanics. For pain management, we provide hot or cold pack, electrical stimulation, and ultrasound as needed.
Let’s do the math. Normal overhead motion from the shoulder is about 180 degrees. 120 degrees (2/3 of the motion) occurs at the glenohumeral joint, or the shoulder joint. 60 degrees (1/3 of the motion) comes from the scapular motion. Too much or too little in either of these areas cause shoulder impingement or limited shoulder flexibility.

If conservative treatments such as physical therapy do not improve your shoulder condition, your physician may recommend shoulder surgery.

Post-surgical shoulder patients:

You may have a sling for 1-2 days, or for 4-6 weeks to support your arm, depending on the type of surgery. Your physician will determine when you will begin physical therapy.