Date of Award

1993

Document Type

Scholarly Project

Degree Name

Master of Physical Therapy (MPT)

Department

Physical Therapy

First Advisor

Henry C. Wessman

Keywords

Shoulder Impingement Syndrome

Abstract

Shoulder impingement syndrome is believed to be the most common cause of shoulder pain in adults, and the major shoulder problem in sports medicine. It develops in a progressive manner to bind the rotator cuff and subacromial bursa beneath the coracoacromial arch superiorly and the upper humerus inferiorly. If left untreated, rotator cuff degeneration and eventual partial or complete tears of the tendons may result.

This report focuses on stage 1 and 2 of impingement syndrome, excluding calcific tendinitis and known rotator cuff or biceps tears. Through a search of the literature, normal and pathologic anatomy and biomechanics will be examined. Rotator cuff vascularity, abnormal shoulder anatomy and biomechanics, trauma, and degeneration are eitologic factors which are discussed. These may be solely or jointly responsible for the symptoms and dysfunction produced by impingement syndrome.

A thorough evaluation is necessary to diagnose shoulder impingement syndrome. General shoulder evaluation procedures are performed, along with special tests for impingement and instability. Once diagnosed, early intervention is crucial in the treatment of this problem. Conservative management is highly successful in stage 1 and 2 and may consist of medications, rest, physical modalities, sport or activity modification, exercise and prevention. The physical therapist is skilled in evaluation of this condition, and can work with the physician and patient to develop a rehabilitation program.

The exercise prescription initially may include isometrics, but will advance to isotonics, use of resistive equipment, and possibly isokinetics. Special attention is paid to strengthening and balancing the shoulder internal and external rotators. Considering the rotator cuff vascularity, EMG studies, and patient comfort, rotational exercises may be more effective if done with the arm positioned in slight flexion and abduction. The scapular rotators are also vitally important in rehabilitation of shoulder impingement syndrome. A majority of patients will respond to conservative, nonoperative efforts and will be able to resume sport or job activities.

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