Rehabilitation principles and practice for shoulder impingement and related problems
- Craig Parsons, MS, PT
Craig Parsons, MS, PT
- The Physical Therapy Network
- Section Editor
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
Shoulder impingement syndrome (SIS) refers to a combination of shoulder symptoms, examination findings, and radiologic signs attributable to the compression of structures around the glenohumeral joint that occurs during shoulder elevation. Such compression causes persistent pain and dysfunction. SIS is a common cause of shoulder pain among patients presenting to primary care clinics.
The principles of rehabilitation and a physical therapy program for the treatment of SIS are discussed here. The risk factors, pathophysiology, diagnosis, and general management of SIS and other shoulder problems are reviewed separately. (See "Shoulder impingement syndrome" and "Rotator cuff tendinopathy" and "Presentation and diagnosis of rotator cuff tears" and "Frozen shoulder (adhesive capsulitis)" and "Evaluation of the patient with shoulder complaints" and "Physical examination of the shoulder".)
DEFINITION AND CLASSIFICATION
Glenohumeral or shoulder impingement syndrome (SIS) is a chronic condition that develops when soft tissues are repeatedly compressed between the humeral head and the acromion when the arm is actively raised. SIS refers to a combination of shoulder symptoms, examination findings, and radiologic signs, rather than injury to a specific structure. However, shoulder impingement predisposes to rotator cuff tendinopathy and tears.
Most often SIS results from overuse in middle-aged adults. Throwing athletes suffer from a unique form of SIS: Impingement of the superior and posterior labrum and rotator cuff occurs with external rotation, extension, and abduction of the shoulder (ie, the cocking phase of throwing). The different types of SIS and their pathophysiology are reviewed separately. (See "Shoulder impingement syndrome", section on 'Pathophysiology'.)
ANATOMY AND BASIC BIOMECHANICS
The anatomy and basic biomechanics of the shoulder are reviewed separately (figure 1 and figure 2 and figure 3 and picture 1). (See "Evaluation of the patient with shoulder complaints", section on 'Anatomy and biomechanics'.)
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- DEFINITION AND CLASSIFICATION
- ANATOMY AND BASIC BIOMECHANICS
- PRINCIPLES OF REHABILITATION
- REHABILITATION PROGRAM
- Step one: Improve scapular stability
- Step two: Strengthen the rotator cuff
- - Supraspinatus
- - External rotators (infraspinatus and teres minor)
- - Subscapularis
- Step three: Improve overall strength and coordination of shoulder complex
- WHERE TO BEGIN
- EVIDENCE SUPPORTING THIS APPROACH
- SUMMARY AND RECOMMENDATIONS