One of the most common conditions that affects our society is impingement and tendonitis of the rotator cuff or shoulder.
There are four muscles (the rotator cuff) surrounding the shoulder blade that attach to the top of the long bone of the upper arm the humerus. When these and other muscles of the back and shoulder are too tight or are lengthened and weak, there can be changes to the typical mechanics of the shoulder (Harryman et al 1990). What can often happen is that this leads to pinching and irritation of the tendonous area of the rotator cuff muscles. These tendons sit under a protrusion of bone from the scapula and can be pinched between this protrusion and the top of the humerus. For the individual this causes pain during reaching and certain movements like lifting the arm over head.
The Physiotherapist’s role in the evaluation of this type of condition is to understand what is happening with the scapular muscles during movement and stabilization of the scapula and the shoulder joint. Often time what is known as posture or the relationship of the boney structures of the skeleton contributes to an impingement syndrome and tendonitis. Stretching and strengthening specific areas can change posture and the tendency for impingement.
Another part of the anatomy that can contribute to this condition is the state of the shoulder joint capsule. If it is tight or loose in any particular area it can cause the humerus to be pushed in one direction or the other especially during movement. Treatment in the form of manual therapy (gliding) the joint in one direction can decrease restrictions in one direction and prevent excessive movements in the directions that cause impingement. The capsule can also be stretched with specific stretches or reinforced by strengthening select muscles.
Manual therapy mobilizations can assist with increasing range of motion, and decreasing pain (Teys et al 2006) and therapeutic ultrasound is useful to decrease inflammation and promote collagen healing.
A study by Senbursa et al 2007 showed that patients treated with manual physical therapy and supervised exercise (3x/week) had pain scores that went from 6.7 to 2.0 out of 10 after 12 sessions. These patients also had improved range of motion, strength and function.
Do you have shoulder pain? You don’t have to live with it! Book your appointment today!
Angie Marsman PT, P.Kin.