Impingement Syndrome

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Shoulder impingement syndrome is a painful condition that can make almost everything you do on a daily basis, from brushing your hair to reaching for items on a high shelf, difficult and sometimes impossible.

People with this condition usually complain of an ache in the shoulder, which becomes a sharp pain when they raise their arm to the front or the side of their body. They may also experience weakness and a decreased range of motion. All the symptoms usually worsen while they sleep, especially if they have a tendency to roll onto the affected shoulder.

Tennis players, pitchers and swimmers are among those most susceptible to shoulder problems, as repeated overhead movements can cause irritation and swelling in the joint. People who tend to sleep with one arm above their head or under their pillow may also be at risk.

Shoulder impingement syndrome is a complex condition, commonly mistaken by health-care providers for similar disorders in the shoulder like tendonitis, bursitis, or muscle tears. These conditions are all closely related and produce similar, almost indistinguishable symptoms.

In fact, impingement syndrome can develop when patients treat other shoulder conditions, like those mentioned above, improperly. Without proper care, these conditions cause shoulder dysfunction, and over time the body responds by producing scar tissue.

It's the scar tissue that interferes with the usual motion of the shoulder joint, much the same as rust on a bolt makes it hard to twist in a screw. Your shoulder only has enough space for the essentials: the muscles that move the arm, the tendons that connect muscle to bone, the ligaments that connect bone to bone and the cushioning tissues that protect them all. Impingement refers to the pinching or rubbing among these tendons, ligaments and bones, which intensifies when you lift your arm, and becomes painful when scar tissue joins the crowd.

Living with shoulder impingement syndrome isn't easy, as it affects almost everything you do. It's therefore imperative that you seek care from your healthcare practitioner if you suspect you have the condition. Using a variety of techniques, he or she may be able to decrease the amount of scar tissue in your shoulder and rehabilitate the area.

Anatomy

Your shoulder is made up of many bones: the clavicle (collarbone), the humerus (upper arm bone), the scapula (shoulder blade) and the acromion, which makes up the highest part of the shoulder.

For these bones to move, they need muscles. Muscles are attached to tendons, which connect to bone. When a muscle contracts, it pulls a tendon, which then pulls the bone in the desired direction.

In the case of your shoulder, these muscles are the supraspinatus, infraspinatus, teres minor and subscapularis. Collectively, these are called the rotator cuff muscles, aptly named as they form a cuff around the shoulder, much like a shirtsleeve surrounds your wrist. These muscles, along with their associated tendons, connect the humerus and the scapula, helping you raise and rotate your arm.

In order for tendons to do their job, they have to pass through an area called the subacromial space, right below the acromion. This space gets smaller when you raise your arm, as the humerus and the acromion move closer together.

When this happens, the tendons passing through rub against the surrounding tissue. This rubbing occurs in everyone's shoulder to some degree.

To prevent the rubbing from irritating tissue, a lubricated sac called a bursa surrounds the tendons. Under ordinary circumstances, the bursa in your shoulder is sufficient for preventing irritation from the rubbing of tendons and bone. Activities that require a lot of overhead movements, however, like tennis or swimming, can cause excessive friction, making the tendons irritated, inflamed and weak.

Consequently, your body lays down new tissue, called scar tissue, to compensate for the weakened tendons. This is your body's natural reaction to tissue damage, whether it is a result of recent injury or previous conditions that don't receive treatment.

When this happens, it causes two problems. First, scar tissue isn't as functional as healthy tendons. It's thick and rigid, making proper movement difficult. Second, scar tissue takes up too much room in the subacromial space, crowding the tendons even more. This crowding gets worse when you raise your arm, as the subacromial space gets smaller. That's why patients with shoulder impingement complain of a sharp pain when they lift their arm.

Those affected with shoulder impingement syndrome often need to make lifestyle changes to reduce pain. It's also important they seek chiropractic care, which can reduce scar tissue and get the shoulder functioning properly again.

Chiropractic Care

In caring for your condition, your chiropractor has a variety of options. After a thorough examination of your shoulder, he or she will decide what will work best for you.

If you visit your chiropractor with mild to moderate symptoms of shoulder impingement syndrome, conservative care is usually sufficient. This includes resting the shoulder and easing up on contributing activities. For patients participating in swimming, pitching or other activities that involve the shoulder, it's advisable to stop. The same holds for jobs that require extensive use of the shoulder, and any activities that involve overhead arm movement.

Depending on the specifics of your condition, your chiropractor may also perform a mobilizing technique that will stretch tissue, increase blood flow to the muscles and broaden the arm's range of motion. To perform this, he or she will take the shoulder and gently move it within its normal range of motion. This slowly and painlessly reintroduces movement to the area.

If the joints in your upper back or neck are stiff, your chiropractor might concurrently perform an adjustment, also known as spinal manipulative therapy. Adjustments help restore proper motion in the joints, enable the spine and nervous system to function optimally and assist in relaxing tight muscles associated with your shoulder.

Physiotherapeutic devices like ultrasound or interferential current (IFC) are also common tools chiropractors use to care for shoulder impingement syndrome. Ultrasound delivers high frequency sound waves deep into the tissues of the shoulder. Depending on the waves' frequency, this can increase blood flow, decrease pain, reduce muscle spasm, break down scar tissue and speed healing. IFC works in much the same way, only with an electrical current. This mild, painless current disperses excess fluid in the shoulder, decreases painful swelling and inflammation, stimulates the nervous system and promotes healing.

Once the pain begins to subside, it's important that you aim to regain the strength of your shoulder by performing stretches, lightweight exercises and aerobic activity. Your chiropractor can tell you when your shoulder is ready for such activity.

As your shoulder heals, your chiropractor will probably also urge you to maintain a regular exercise routine that involves functional exercises, which are exercises that target the muscles you use in everyday activities. If you were a painter, for example, your chiropractor would probably prescribe functional exercises that condition your arms.

Proprioceptive exercises are also helpful, as they focus on a particular group of muscles and force them to work together. Because patients with impingement syndrome tend to stop using their shoulder when movement becomes painful, their muscles can become weak and fatigued. This forces muscles in their neck to compensate, and disrupts the brain's communication with the body. Your neck has proprioceptive nerves, which send messages to your brain to help you with balance and coordination. If your neck is overtired, however, the communication system gets disrupted.

While such conservative and non-invasive chiropractic management is the safest approach for shoulder impingement syndrome, in certain cases surgery may be necessary. If so, your chiropractor will be able to make an appropriate referral. Regardless of the treatment, however, successful rehabilitation of shoulder impingement syndrome largely depends on patient cooperation. While your chiropractor plays a vital role in your recovery, it's ultimately up to you to commit to a lifestyle that promotes the health of your shoulder.

Impingement Syndrome

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