Tag Archives: shoulder impingement syndrome

Shoulder Pain Treatment: Rotator Cuff, Impingement Syndrome

Shoulder Pain Rotator CuffToday I want to let you know a bit more about what causes shoulder pain. It is common for a patient to come into a chiropractic clinic complaining of a shoulder pain or injury. Maybe you know the feeling of not being able to lift your arm or put a bra on or reach behind your back all because of a pain in your shoulder.

So again, today you will learn more about the anatomy of the shoulder, including the rotator cuff muscles, and the two most common shoulder injuries we see at the chiropractic clinic: impingement syndrome, and rotator cuff tearstendonitis.

Shoulder Anatomy

The shoulder girdle is composed the humerus (arm bone), scapula (wing bone) and clavicle (collar bone). These shoulder girdle bones articulate (join) with each other forming the three joints of the shoulder girdle:

  1. Sternoclavicular joint,
  2. Acromioclavicular joint,
  3. Glenohumeral joint.

The primary role of the shoulder complex is to position the hand in space; therefore a large amount of shoulder joint movement is necessary. The increased movement is accompanied with a decrease in bony stability causing an increased demand on the surrounding soft tissues, like the rotator cuff muscles.

The static stabilising mechanisms of the shoulder include:

  1. The joint capsule,
  2. Joint adhesion and geometry,
  3. Ligamentous support.

Dynamically the shoulder stabilising muscles include the rotator cuff muscles comprising of:

  1. Suprapinatus,
  2. Infraspinatus,
  3. Teres minor,
  4. Subscapularis muscles,
  5. Biceps brachii muscle.

The rotator cuff muscles provide stability by inserting into the capsule and have a tightening effect upon contraction. The normal shoulder stabilising mechanisms are compromised in alterations in the normal structural alignment of the scapula and humerus and in rotator cuff muscle weakness.

Shoulder Pain Anatomy Video

In the following video you can watch why having weak shoulder blade muscles and bad shoulder movements can lead to a shoulder pain problem.

Shoulder Muscles

The shoulder muscles can be broken down into several categories according to their function.

The first category is “the protectors” which are the rotator cuff muscles.  These muscles compress the humeral head into the glenoid cavity of the scapula increasing joint adhesion.

The second category is “the pivoter’s” which pivot the scapula (shoulder blade) under the humeral head during elevation of the arm. The pivoter’s  function is to maintain muscle/tendon alignment and tension. The pivoting muscles include the serratus anterior and the trapezius.

The deltoid complex and supraspinatus muscles are categorised as “the positioning muscles”.  Their main function is to position the shoulder in varying degrees of elevation.

The strength of the shoulder is controlled by the internal and external rotator muscles which are categorised as “the propellers”.  The internal rotators namely the pectoralis, subscapularis, teres major and latissimus dorsi muscles are much larger than the external rotators of the shoulder. A natural imbalance between the stronger internal rotators and weaker external rotators exists. This imbalance is often made worse by the over development of the larger muscles (weights at gym) and by occupational posture (slouched laptop posture). The external rotators are the infraspinatus, teres minor and posterior deltoid muscles.

Common Shoulder Pathologies (Injuries)

Shoulder Pain1. Impingement Syndrome

Impingement syndrome has the typical presentation of shoulder pain which is worse on overhead activities. Patients suffering from impingement syndrome are usually involved in sports or work that requires overhead positions eg. swimming, tennis, painters, welders etc.

The site of the tenderness depends on the where the actual impingement is occurring. It can be either the front or back of the shoulder.

Shoulder Impingement Risk Factors

There are both structural and functional risk factors in the development of impingement syndrome.  Structural causes include a variation in the acromion process which is a structure of the scapula.  In some cases this structure is lengthened, hooked or has undergone degenerative changes which decrease the underlying space where the tendons run predisposing them to impingement especially during elevation and internal rotation.

Another risk factor is shoulder instability which allows for excessive upward movement of the humeral head compressing the tendons

Shoulder Impingement Prevention

Functional impingement syndrome can easily prevented be strengthening the rotator cuff muscles i.e. the supraspinatus, infraspinatus, teres minor and subscapularis.  This will prevent excessive movement of the humerus when moving the arm.

Shoulder Impingement Treatment

Management of this condition depends on the severity of the symptoms.  In the acute stages treatment will be aimed at decreasing inflammation and pain this will be achieved through soft tissue work, shoulder mobilization and manipulation and exercises.

As the pain decreases the treatment is more focused on increasing the rotator cuff strength while avoiding the impingement position. The final stage of treatment includes training the shoulder through the impingement range.

2. Rotator Cuff Syndrome

Rotator cuff syndrome encompasses many conditions including rotator cuff tears and rotator cuff tendonitis.

A torn rotator cuff muscle commonly occurs due to a traumatic event for example lifting a heavy object or falling on an outstretched arm, however, in older patients it can also occur insidiously. Repetitive shoulder movement activities with an underlying shoulder problem can lead to chronic degenerative changes in the muscle tendon. These changes then predispose the rotator cuff tendon to tear.  A torn rotator cuff muscle can be classified as partial or complete.

The reason rotator cuff tendonitis occurs in young active individuals is mainly due to the overuse of poorly conditioned soft tissue e.g. tennis players; and in older people mainly due to a poor blood supply to the tendon area. It is common in both males and females.

Rotator Cuff Symptoms

The major symptom of a rotator cuff complaint is pain over the shoulder area. Depending on the involved structure the shoulder pain may radiate down the arm, over the deltoid muscle. If there is a tear in the rotator cuff then weakness in your shoulder and difficulty lifting your arm may accompany the shoulder pain.

Rotator Cuff Treatment

Rotator cuff syndrome represents a chronic shoulder impingement syndrome. That means rest alone is often not sufficient for total resolution of the problem, although it might decrease the shoulder pain. It is important to reduce the mechanical stress on the irritated shoulder tendon or soft tissue whilst trying to reduce shoulder pain and inflammation.

The treatment of the rotator cuff syndrome is dependent on its severity. Initial shoulder pain treatment is conservative and is directed towards symptomatic pain relief. This is done by trying to reduce inflammation and promote a mobile scar tissue development. The ultimate objective is to restore normal, pain-free shoulder and shoulder blade movement. As the shoulder pain subsides a gradual strengthening and shoulder rehabilitation exercise program is initiated.

Your chiropractor can help you with the initial shoulder rehab exercises, but it is recommend that you have one on one exercise supervision. So consulting a biokinetist or physiotherapist to draw up a shoulder exercise plan for you and watch you do them correctly is important for the long-term prevention.

If you have any questions or worries about your shoulder pain and what you should do to help then why not ask a chiropractor a question using our online contact form.