Impingement Syndrome - Treatment

Treatment

Impingement syndrome is usually treated conservatively, but sometimes is treated with arthroscopic surgery or open surgery. Conservative treatment includes rest, cessation of painful activity, and physiotherapy. Physiotherapy treatments would typically focus at maintaining range of movement, improving posture, strength of the muscles of the shoulder and scapula, and reduction of pain. Physiotherapists may employ the following treatment techniques to improve pain and function: Joint Mobilization, Interferential Therapy, Acupuncture, Soft Tissue Therapy, Therapeutic Taping, Scapular and rotator cuff Strengthening, and Education regarding the cause and mechanism of the condition.NSAID's and ice packs may be used for pain relief.

Therapeutic injections of corticosteroid and local anaesthetic may be used for persistent impingement syndrome. The total number of injections is generally limited to three due to possible side effects from the corticosteroid.

Corticosteroids actually cause musculoskeletal disorders, which explains the low success rate of cortisone injections. Research has shown that over 90% of tendinopathies have no inflammation, thus the term tendinosis is more appropriate than tendinitis for most diagnoses. For tendinosis, prolotherapy injections or cross-fiber (transverse) friction massage can be very effective.

A number of surgical interventions are available, depending on the nature and location of the pathology. Surgery may be done arthroscopically or as open surgery. The impinging structures may be removed in surgery, and the subacromial space may be widened by resection of the distal clavicle and excision of osteophytes on the under-surface of the acromioclavicular joint. Also damaged rotator cuff muscles can be surgically repaired.

Cools, Witvrouw, Mahieu, and Danneels (2007) researched isokinetic scapular muscle performance in overhead athletes with and without shoulder impingement to identify any deficits in the scapular muscles of athletes with shoulder impingement. Using 30 overhead athletes with shoulder impingement (21 males and 9 females) and 30 overhead athletes (18 males and 12 females) without shoulder pain (mean age of 23.2 years old) they measured scapular protraction and retraction of the scapula at two different velocities (12.2 cm/s and 36.6 cm/s). Using valid and reliable measures, Cools et al. found that overhead athletes with shoulder impingement had decreased force output at both velocities in the protractor muscles compared to their uninjured arm and uninjured overhead athletes. Cools et al. (2007) used the importance of scapular strengthening and observed muscle activity of the upper trapezius, middle trapezius, lower trapezius and serratus anterior during twelve rehabilitation exercises to determine which exercises are the best for scapular strengthening and scapular balance. They used forty-five healthy college-aged students (twenty men and twenty-five women with an average age of 20.7 years old) and placed surface electrodes on the four muscles during the randomized order of the rehabilitation exercises. They found five exercises that had optimal utilization of each of the four scapular muscles: horizontal abduction with external rotation, side lying external rotation, side lying forward flexion, side lying forward flexion, and prone extension. Wilk, Meister, James and Andrews (2002) also discussed the importance of scapular muscle strength and stability in the rehabilitation of shoulder impingement syndrome. They found that rehabilitation techniques for restoring this strength are manual resistance to the scapula during protraction and retraction as well prone horizontal abduction.

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