The tendons of your rotator cuff live in an area of your shoulder called the "subacromial space". Sometimes this space can become crowded by abnormally shaped bones, arthritis, spurs, or inactive muscles that fail to keep the bones separated properly. This may create a painful pinching of the rotator cuff tendon when you raise your arm.
Chances are, if you were or are a throwing athlete, your workouts contain some overhead press, or you have a job where you repetitively put your arms overhead, such as carpentry. You likely have encountered a shoulder injury, and likely it would have been shoulder impingement. Shoulder impingement can affect other parts of our lives if we do not know how to manage it, even if we stop doing the main activity that promoted the pain.
Any sign of shoulder impingement can be an indication you need to see your local chiropractor. At E3 Chiropractic + Wellness in Saskatoon, we are here to help. If you are dealing with any shoulder pain, we encourage you to schedule an appointment. Our doctors will provide you with the best conservative treatment options for your condition and goals!
Shoulder impingement is typically caused by a decrease in subacromial space between the bursa and the humerus. Repetitive strain on the supraspinatus, infraspinatus, teres minor, and/or subscapularis (SITS muscles) can cause sharp, dull, achy, sometimes throbbing pain or discomfort underneath the acromion process of the Shoulder. Four different factors can cause this:
- AC degeneration- typically do not see normal degeneration until about the 6th decade of life.
- Scapular dyskinesis- athletes with poor control of the joints of the Shoulder, specifically the scapulothoracic joint, through athletic movements can further drive shoulder impingement
- Thickened coracoacromial ligament- this is part of the upper limits for the glenohumeral or Shoulder joint, so thickening of the ligament can reduce this space
- Upper crossed syndrome- otherwise known as bad posture of the upper quadrant of the body.
Scapular dyskinesis and upper crossed syndrome are the two most common causes so we will take a further look into these conditions.
The scapula's position and movement require proper tone and movement of the 17 muscles attached to it. Suppose we have short and tight muscles paired with long and weak muscles surrounding the scapula. In that case, we often get faulty positioning or movement required to get our Shoulders in a good position for daily activities or sports. This can be secondary to various traumas, other shoulder pathology, or hyperkyphosis of the thoracic spine. As a primary or secondary condition, scapular dyskinesis can lead to decentration or improper positioning of the glenohumeral joint causing impingement.
UCS is a postural dysfunction described by Dr. Vladimir Janda as a combination of weak or tonic muscles and tight or phasic muscles we have a predisposition for as humans. Tight muscles include the upper trapezius, SCM, levator scapula, and pectoralis major. In contrast, the weak muscles are typically the rhomboids, middle and lower trapezius, deep neck flexors, serratus anterior, and scalenes. This is often seen with rounding of the shoulders, slumped forward position of the back, and protracted neck or chin jutting. The problems associated with the upper crossed syndrome are headaches, disc bulges, cervical radiculopathy, and impingement or rotator cuff pathology of the Shoulder by limiting or altering the biomechanics of the Shoulder.
Shoulder impingement requires a complete assessment to determine the primary culprit of the pain.
First, we can rule out pathology by asking a series of questions in the history and performing orthopedic and neurological tests. For example, if you had a recent trauma, we may see it necessary to have imaging to rule out a fracture possibility. With a cluster of orthopedic tests, we can better understand what the pathoanatomical, or pain-causing, structure is. This could give us information if we suspect you have a full-thickness tear of your supraspinatus tendon. This could be out of our control as conservative health care providers, especially if you have true muscle weakness.
We further our exam through palpation, motion assessment, and functional tests to give us a more detailed understanding of your condition specifically. These examinations will help us guide our treatment for you.
The treatment can consist of chiropractic manipulation, soft tissue techniques such as Active Release Therapy or Functional Range Release and Instrument Assisted Soft Tissue Manipulation, and corrective exercise. These will help decrease inflammation, speed healing, and restore the joints and muscles' proper movement and biomechanics.