Overview of Shoulder Impingement Syndrome (SIS)
1. Anatomy of the Shoulder
The shoulder joint is a complex structure involving:
• Bones: Humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone).
• Joints: Glenohumeral (ball-and-socket), acromioclavicular (AC joint), and scapulothoracic articulation.
• Rotator Cuff Muscles: Supraspinatus, infraspinatus, teres minor, and subscapularis stabilize and move the shoulder.
• Subacromial Space: Houses the supraspinatus tendon, subacromial bursa, and long head of the biceps tendon.
• Bursae: The subacromial bursa reduces friction between structures.
2. Clinical Presentation
Shoulder impingement typically presents as:
• Pain with overhead or repetitive shoulder movements.
• Weakness in lifting or reaching.
• Limited range of motion due to pain.
• Painful arc sign (pain between 60°–120° of shoulder abduction).
• Night pain, especially when lying on the affected side.
3. Pathophysiology
Shoulder impingement occurs when soft tissues (tendons/bursa) get compressed within the subacromial space, leading to irritation and inflammation. The main causes include:
• Primary Impingement (Structural/Narrowing of Subacromial Space)
• Acromion shape (Type III “hooked” acromion more prone to impingement).
• Bone spurs from osteoarthritis.
• Thickening of the coracoacromial ligament.
• Secondary Impingement (Functional/Muscle Imbalance)
• Rotator cuff weakness.
• Scapular dyskinesis (poor movement control).
• Poor posture (rounded shoulders/forward head).
• Repetitive overuse (e.g., swimming, throwing sports).
• Bursal vs. Tendinous Involvement
• Bursal impingement: Inflammation of the subacromial bursa.
• Tendinous impingement: Supraspinatus tendon irritation.
4. Treatment Approaches
A. Physiotherapy
Goals:
• Reduce pain and inflammation.
• Restore range of motion.
• Strengthen rotator cuff and scapular stabilizers.
• Improve biomechanics and posture.
Techniques:
1. Manual Therapy
• Joint mobilizations to improve scapulohumeral rhythm.
• Soft tissue release for overactive muscles (e.g., pec minor, upper traps).
2. Exercise-Based Rehabilitation
• Scapular Stabilization: Strengthening serratus anterior and lower traps.
• Rotator Cuff Strengthening: Theraband or dumbbell exercises targeting external rotators (e.g., infraspinatus, teres minor).
• Postural Correction: Stretching pectoralis minor and activating deep cervical flexors.
3. Modalities for Pain Reduction
• Shockwave Therapy: Used to stimulate healing in chronic cases.
• Ultrasound Therapy: Helps reduce inflammation.
• TENS (Transcutaneous Electrical Nerve Stimulation): Pain relief.
4. Education & Ergonomics
• Adjusting workstations.
• Avoiding repetitive overhead movements.
• Sleep position modifications.
B. Chiropractic Care
Goals:
• Improve joint mobility.
• Reduce muscular tension.
• Correct postural imbalances.
Techniques:
1. Joint Manipulation & Mobilization
• Adjustments to the thoracic spine to improve shoulder mechanics.
• Mobilization of scapulothoracic and glenohumeral joints.
2. Soft Tissue Techniques
• Myofascial release for hypertonic muscles (e.g., upper traps, levator scapula).
• Active Release Therapy (ART) for rotator cuff and pec tightness.
3. Kinesiology Taping
• Provides proprioceptive feedback and reduces strain on the rotator cuff.
4. Postural Training
• Addressing forward head posture and rounded shoulders.
C. Massage Therapy
Goals:
• Reduce muscle tension.
• Improve blood flow for tissue healing.
• Decrease pain and stiffness.
Techniques:
1. Deep Tissue Massage
• Targets overactive muscles (e.g., deltoids, upper traps, levator scapulae).
2. Trigger Point Therapy
• Focuses on myofascial trigger points in the supraspinatus and teres minor.
3. Lymphatic Drainage
• Helps with chronic inflammation and swelling.
D. Conservative Modalities
1. Shockwave Therapy
• Effect: Breaks down calcifications, increases blood flow, and stimulates healing.
• Indications: Chronic tendinopathies, calcific tendinitis, and persistent impingement.
2. Extracorporeal Shockwave Therapy (ESWT)
• High-energy pulses break down scar tissue and enhance collagen remodeling.
3. Cold Laser Therapy (Low-Level Laser Therapy - LLLT)
• Effect: Reduces inflammation, accelerates healing.
4. Acupuncture/Dry Needling
• Effect: Targets myofascial trigger points, reduces pain.
5. Taping & Bracing
• Effect: Unloads the rotator cuff, corrects posture.
Conclusion
Shoulder impingement is a multifactorial condition that requires a comprehensive treatment approach. Combining physiotherapy, chiropractic care, and massage therapy, along with conservative modalities like shockwave therapy, provides optimal pain relief, improved mobility, and long-term functional recovery.
1. Anatomy of the Shoulder
The shoulder joint is a complex structure involving:
• Bones: Humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone).
• Joints: Glenohumeral (ball-and-socket), acromioclavicular (AC joint), and scapulothoracic articulation.
• Rotator Cuff Muscles: Supraspinatus, infraspinatus, teres minor, and subscapularis stabilize and move the shoulder.
• Subacromial Space: Houses the supraspinatus tendon, subacromial bursa, and long head of the biceps tendon.
• Bursae: The subacromial bursa reduces friction between structures.
2. Clinical Presentation
Shoulder impingement typically presents as:
• Pain with overhead or repetitive shoulder movements.
• Weakness in lifting or reaching.
• Limited range of motion due to pain.
• Painful arc sign (pain between 60°–120° of shoulder abduction).
• Night pain, especially when lying on the affected side.
3. Pathophysiology
Shoulder impingement occurs when soft tissues (tendons/bursa) get compressed within the subacromial space, leading to irritation and inflammation. The main causes include:
• Primary Impingement (Structural/Narrowing of Subacromial Space)
• Acromion shape (Type III “hooked” acromion more prone to impingement).
• Bone spurs from osteoarthritis.
• Thickening of the coracoacromial ligament.
• Secondary Impingement (Functional/Muscle Imbalance)
• Rotator cuff weakness.
• Scapular dyskinesis (poor movement control).
• Poor posture (rounded shoulders/forward head).
• Repetitive overuse (e.g., swimming, throwing sports).
• Bursal vs. Tendinous Involvement
• Bursal impingement: Inflammation of the subacromial bursa.
• Tendinous impingement: Supraspinatus tendon irritation.
4. Treatment Approaches
A. Physiotherapy
Goals:
• Reduce pain and inflammation.
• Restore range of motion.
• Strengthen rotator cuff and scapular stabilizers.
• Improve biomechanics and posture.
Techniques:
1. Manual Therapy
• Joint mobilizations to improve scapulohumeral rhythm.
• Soft tissue release for overactive muscles (e.g., pec minor, upper traps).
2. Exercise-Based Rehabilitation
• Scapular Stabilization: Strengthening serratus anterior and lower traps.
• Rotator Cuff Strengthening: Theraband or dumbbell exercises targeting external rotators (e.g., infraspinatus, teres minor).
• Postural Correction: Stretching pectoralis minor and activating deep cervical flexors.
3. Modalities for Pain Reduction
• Shockwave Therapy: Used to stimulate healing in chronic cases.
• Ultrasound Therapy: Helps reduce inflammation.
• TENS (Transcutaneous Electrical Nerve Stimulation): Pain relief.
4. Education & Ergonomics
• Adjusting workstations.
• Avoiding repetitive overhead movements.
• Sleep position modifications.
B. Chiropractic Care
Goals:
• Improve joint mobility.
• Reduce muscular tension.
• Correct postural imbalances.
Techniques:
1. Joint Manipulation & Mobilization
• Adjustments to the thoracic spine to improve shoulder mechanics.
• Mobilization of scapulothoracic and glenohumeral joints.
2. Soft Tissue Techniques
• Myofascial release for hypertonic muscles (e.g., upper traps, levator scapula).
• Active Release Therapy (ART) for rotator cuff and pec tightness.
3. Kinesiology Taping
• Provides proprioceptive feedback and reduces strain on the rotator cuff.
4. Postural Training
• Addressing forward head posture and rounded shoulders.
C. Massage Therapy
Goals:
• Reduce muscle tension.
• Improve blood flow for tissue healing.
• Decrease pain and stiffness.
Techniques:
1. Deep Tissue Massage
• Targets overactive muscles (e.g., deltoids, upper traps, levator scapulae).
2. Trigger Point Therapy
• Focuses on myofascial trigger points in the supraspinatus and teres minor.
3. Lymphatic Drainage
• Helps with chronic inflammation and swelling.
D. Conservative Modalities
1. Shockwave Therapy
• Effect: Breaks down calcifications, increases blood flow, and stimulates healing.
• Indications: Chronic tendinopathies, calcific tendinitis, and persistent impingement.
2. Extracorporeal Shockwave Therapy (ESWT)
• High-energy pulses break down scar tissue and enhance collagen remodeling.
3. Cold Laser Therapy (Low-Level Laser Therapy - LLLT)
• Effect: Reduces inflammation, accelerates healing.
4. Acupuncture/Dry Needling
• Effect: Targets myofascial trigger points, reduces pain.
5. Taping & Bracing
• Effect: Unloads the rotator cuff, corrects posture.
Conclusion
Shoulder impingement is a multifactorial condition that requires a comprehensive treatment approach. Combining physiotherapy, chiropractic care, and massage therapy, along with conservative modalities like shockwave therapy, provides optimal pain relief, improved mobility, and long-term functional recovery.