An ever-increasing number of Americans are becoming more active in their quest for a healthier lifestyle. Aerobic exercise classes, weight training, competitive sports activities, not only results in increased strength and endurance, but, all too frequently, injuries and overuse problems. Shoulder pain syndromes, commonly diagnosed as impingement syndromes—tendon or nerve caught within the joint, are being seen in greater numbers at our physical therapy practices.

The design of the shoulder joint for maximal mobility results in a compromise in the degree of structural stability. Regardless of the cause of shoulder dysfunction, if improperly or inadequately treated, the shoulder quickly loses range of motion and is nearly impossible to regain without formal physical therapy intervention.

Shoulder pain can result from internal disorders from poor body mechanics. The obvious symptom of impingement is pain or dysfunction of the rotator cuff--made up of four major muscles, S.I.T.S. (supraspinatus, infraspinatus, teres minor, and subscapularis).

Physical findings for these syndromes include tenderness to touch over the front of the shoulder joint at the muscle insertion point, a pain through an arc of abduction between 70-120 degrees, or painful testing during passive (with help) ranges.

These impingements usually begin as bicep or rotator cuff tendonitis, which fall into various stages.

Stage one, edema and hemorrhaging at the insertion point of the muscle occurs.

Stage two, the bursa is involved and there is a thickening and fibrosing—scar tissue of the rotator cuff, leading to increased impinging of the tendon. Pain is present during activity and increases afterward. Weakness begins with simple activities such as lifting the arm.

Stage three there becomes a permanent thickening of the rotator cuff and frequent spurring of the top and/or bottom of the shoulder joint as well as a 1 cm tear of the tendon.

Stage four there is chronic pain and dysfunction of the arm as well as continuing tearing of the rotator cuff. By this time surgery and post operative physical therapy is a must to regain ones function.

Shoulder pain, which does not require surgery, can be treated with conservative rehabilitation procedures as soon as diagnosed. Specific protocols are followed and determined by the physician and/or physical therapist. They include a variety of scapular stabilization exercises to increase the integrity of the rotator cuff and biceps as well as treatments—ice, electric stim, ultrasound, etc., to decrease edema, pain and muscle atrophy.

In order to avoid these problems always keep in mind that while engaging in athletic activities one must note correct body mechanics and proper form with movement at the shoulder joint. If you are uncertain, or if you have an existing problem and it has been recurring see us at APTA. We are always open for questions and answers to these types of pathologies.