How does the shoulder joint work?
In a healthy shoulder the humerus (the bone in your arm) needs to glide over several tendons, a bursa (a special cushion in the shoulder) and a bony outcropping – called the acromion- to allow for ease of movement and full range of motion. Several muscles (the rotary cuff – supraspinatus, infraspinatus, subscapularis, teres minor) provide stabilization of the humerus, so it can tuck under these structures and avoid irritating the surrounding shoulder capsule. When all the components are in balance, you will experience full range of movement and no pain.
What is shoulder impingement syndrome?
Shoulder impingement syndrome is one of the most common causes of shoulder pain. It occurs when the head of humerus is unable to stay centered in the shoulder joint and rubs on tendons or a bursa within the shoulder capsule.
Shoulder impingement involves three main structures – supraspinatus tendon, bicipital long head tendon or subacromial bursa.
The pain you’re experiencing indicates, the head of humerus is hitting ligaments and/or acromion and/or pinching bursa.
There are two primary causes:
- Primary – impingement related to the bony structure called acromion. In some individuals, the acromion has an unusual shape resulting in tendons/muscles/humerus to not track correctly.
- Secondary – impingement related to activities, posture, and muscle imbalances.
The constant friction and rubbing result in inflammation and swelling. With compression or “impingement” causes micro trauma to the tendons in the shoulder, resulting in thinning of the affected area. At this point, shoulder impingement syndrome is reversible and will respond quickly to acupuncture.
Without intervention, tissue in the shoulder will become thick and degenerate, leading to tendinopathy and a probable tear in the effected tendon. Recovery time greatly increases at this point.
Causes of Impingement Syndrome:
- Repetitive overhead movements are a risk factor in developing impingement syndrome – as in painting, lifting weights, swimming.
- Rotary cuff muscles imbalances.
- Internal rotated shoulder/slumped shoulder (common in officer workers/drivers) – causing rotary cuff imbalances.
Symptoms of Impingement Syndrome:
- Pain with raising arm overhead.
- Pain reaching behind or reaching up – as in putting on a sweater or coat.
- Weakness in the shoulder.
- Pain sleeping on the effected shoulder.
- Pain in 60 to 120 range of motion.
The amount of damage is usually related to the chronicity of the problem. Acute impingement maybe from a micro tearing of the supraspinatus tendon leading to swelling and edema. With repetitive impingement from overhead activities, the subacromial bursa becomes toughened and thickened and the supraspinatus tendon becomes further inflamed. Chronic degenerative changes may involve a partial or complete tear of the tendon and possible bone spurs. When left untreated, impingement will progress from a treatable pain situation to irreversible rotator cuff tendinitis and tearing.
Rupture of the supraspinatus tendon
Rupture of the supraspinatus tendon can be a partial or total rupture that occurs mostly in the older athlete (over 40) who after a long period of inactivity, starts to train and or compete. If the rotary cuff is weak or injured, the joint can be unstable leading thinning of supraspinatus tendon that results in degenerative tear or rupture.
I approach treating your impingement syndrome to your presentation, which involves:
- Analyzing your posture – is a slumped shoulder playing into your pain?
- Discussing potential lifestyle dynamics impacting the effected shoulder.
- Understanding how other factors such as bone spurs/arthritis can aggravate the problem.
- Muscle testing the muscles comprising the shoulder for weakness and pain.
- Targeting effected muscles, releasing motor points, trigger points and relaxing the fascia
Providing exercises to continue treatment success between acupuncture treatments.
Call (914) 572-5137 today or click here to schedule an appointment & learn more about how we can help you.