The Landings & Bay Colony

24

Shoulder Impingement Syndrome

By Mary Ann Towne PT, DPT, MS

T

here is an old axiom in medical musculoskeletal
circles in that if we all live long enough we’ll all have
some type of pain in our low back and/ or shoulder-

rotator cuff region. As it relates to the shoulder, if you lift
heavy weights out to the side of your body, stand on your
head with yoga or are involved with repetitive
lifting/reaching associated with your work or leisure
activities, you may be at risk for development of shoulder
impingement syndrome. 

The majority of problems associated with the rotator cuff or
subacromial area are due to wear and tear over time
versus a traumatic incident. People who perform repetitive
mid-range to overhead movements are susceptible to
subacromial pain which includes the rotator cuff and long

head of the biceps tendon, multiple bursas
and the acromioclavicular joint. Surgeons,
dentists, physical therapists, painters,
baseball pitchers, tennis players, hair
dressers and yoga enthusiasts (especially
those who stand on their head) are all prone
to development of shoulder impingement
pathology and pain. Very often people don’t
realize the degree of their shoulder
involvement until that final grocery bag lift,
door push or some other routine movement
tips their shoulder into pain.

Pain with the shoulder is diagnosed initially
by the orthopedic surgeon or physical
therapist using common, universally-
performed provocative tests/movements to
see if pain or discomfort is elicited. This is
very much as when you see the ER physician
and he/she pokes your belly to see if you
have tenderness /pain in the event of an
appendicitis. With the shoulder, if pain is
provoked it is considered a positive test for
shoulder/subacromial involvement. No pain
with testing indicates the problem is referred
from another structure; in this case a
possible cervical/neck issue or the shoulder
issue is chronic with no acute symptoms

present. Common tests are the supraspinatus or Neer’s test
for the rotator cuff, Speed’s test for the biceps, Hawkins
test for impingement syndrome and horizontal
adduction/crossover test for the A/C joint. If the patient
presents with moderate to significant pain the orthopedic
MD may have an MRI performed to determine the specific
pathology involved. 

Once diagnosed, the appropriate treatment will be
determined. With mild to moderate findings, it is more than
likely the patient will undergo a program of physical
therapy to restore scapular stability, capsular pliability and
cervical posture. Yes, forward head posture has a definite
negative effect on the subacromial area. With improper

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