SHOULDER IMPINGEMENT

PT Intervention Strategies

By Parley Anderson, DPT

Shoulder Impingement

WHAT’S THE PROBLEM????????

https://www.youtube.com/watch?v=FAh_8erWyQw

Shoulder Impingement and PT Treatment

What does the Research Say?

Studies have shown that designing a specific evidence-based program for each patient is more effective and beneficial compared to a more cookie cutter approach using the same interventions for all patients with shoulder impingement (Ebuagh et al., 2010).

Factors to be considered in prescribing interventions:

Classify the impairments believed to be causative to the individual's pain and functional limitations.

Create an impairment based restoration program.

PHYSICAL THERAPY INTERVENTIONS

For an effective anterior shoulder stretch, place the hand over the head, shoulder in 90° of abduction and 90° of external rotation, and lean forward on a door frame (Ebuagh et al, 2010).

Scaption with thumb- up exercise for strengthening.

Y- exercise. Standing with the arms at the sides, move the shoulders into extension against resistance of an elastic band. Studies have shown better results in electromyographic activities for strengthening the trapezius muscle (Ebaugh et al, 2010).

EXERCISES FOR SHOULDER IMPINGEMENT

Eccentric Strengthening Exercises

Full can scaption with a dumbbell (starting position must be pain-free). Eccentric external rotation using a dumbbell in sidelying position.

(Studies show that adding eccentric exercises to traditional shoulder rehab protocols can increase strength and decrease pain (Maenhout et al, 2012; Bernhardsson et al, 2011.)

PNF Paired with Trigger Point Release

Trigger point release of the subscapularis Contract/relax of the subscapularis to move into greater external

rotation PNF D2 flexion pattern

This treatment was found to decrease pain and increase glenohumeral ER plus overhead reach (AlDajah & Unnikrishnan, 2014).

PT and Shoulder Impingement: A New

ApproachMy Physical Therapy Evaluation:

History (DOI, MOI, Past Treatments, Surgery etc) Establish baselines:

Pain levels/Location of PainROM (Active/Passive)StrengthSpecial Test/Concordant Sign/Functional TestDevelop Provisional Diagnosis

DerangementDysfunction

Test Hypothesis (Apply Mechanical Forces/Strategies)Re-Assess BaselinesConfirm/Deny Hypothesis

Shoulder ImpingementDerangement:

Symptoms rapidly changeable (i.e can get better/worse quickly)

Symptoms can be constant or intermittentROM rapidly changeableCan be acute, sub-acute or chronic lesion Can become dysfunctions over timeRx: Reduce the derangement

Directional PreferenceAnatomical Cause:

Disruption of Joint SurfacesEncroachment of Meniscoids in joint space

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Shoulder ImpingementDysfunction:Symptoms (when present) are more consistent in natureSymptoms are more intermittent (no pain when tissue is on

slack)ROM is consistentPain is usually found at End Range (stretch short/tight

tissue)Lesion must be 10-12 weeks or older (mostly chronic

lesions)Rx: Remodel TissueAnatomical Cause

Joint adhesions/ContractureMaladaptive muscle shorteningScar tissue formation

Shoulder ImpingementDirectional Preference Direction of motion/force that may do one or more of

the followingReduce painRestore motionImprove strengthImprove functionImprove concordant sign/special test

Directional PreferencePreferred treatment strategy for derangementsMay be painful to performMay be painless to performMay feel “good” to perform

SHOULDER EXTENSION

SHOULDER EXTENSION

INTERNAL ROTATION

INTERNAL ROTATION

INTERNAL ROTATION

HORIZONTAL ABDUCTION

HORIZONTAL ADDUCTION

https://www.wetransfer.com/downloads/2beb09622bf9f050ac748092a7380c3c20150729111750/15be1f7b5b748c974f7f08e6a856160320150729111750/f533eb

AlDajah, SB. & Unnikrishnan, R. (2014). Subscapularis trigger release and contract relax technique in patients with shoulder impingement syndrome. European Scientific Journal (2014). 10(30): 408-416. Retrieved July 29, 2015, from ProQuest database.

Berhardsson, S., Klintberg, IH., Wendt, GK. (2011). Evaluation of an exercise concept focusing on eccentric strength training of the rotator cuff for patients with subacromial impingement syndrome. Clinical Rehabilitation 25:69-78. Retrieved July 29, 2015, from ProQuest database.

Ebaugh, D., Fleming, J, Seitz, A., (2010). Exercise protocol for the Treatment of Rotator Cuff Impingement Syndrome. Journal of Athletic Training, 45(5). 483-5. Retrieved July 29,2015, from ProQuest database.

Maenhout, AG., Mahieu, NN., DeMuynck M., DeWilde, LF., Cools, AM. (2012). Does adding heavy load eccentric training to rehabilitation of patients with unilateral subacromial impingement result in better outcome? A randomized,

clinical trial. Knee Surgery, Sports Traumatology, Arthroscopy (2013), 21:1158-1167. Retrieved July 29, 2015, from ProQuest database.

Mckenzie Institue

REFERENCES

Shoulder Impingement

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