IMPINGEMENT SYNDROME

 INTRODUCTION:- Impingement is the inflammation produced by the injury of rotator cuff muscles around coracoacromial arch. It occurs mostly in throwers and patient comes with the chief complaints of having difficulty in performing overhead rotational movement.

CAUSE:- The cause of impingement can be -

 i) supraspinatus tendonitis

ii) bicipital tendonitis

iii) coracoacromial bursitis

iv) calcification in any of above tendons leading to tear.

v) hook type of acromion.

CLINICAL FEATURES:- The patient generally fall in the age of 40-60 years. ROM of forward flextion and abduction is restricted beyond 100 degree in internally rotated position. Effusion may or may not be present. Instability may or may not be present.

SPECIAL TESTS:- 

  -: PAINFUL ARC TEST:-

Purpose of Test-  To test for the presence of subacromial impingement.

Test Position- Sitting or Standing

Performing the Test-  In this, the patient is asked to elevate (either flexion or abduction) the arm. The test is considered POSITIVE if the patient has pain in between 60-120 degrees of the movement.

  -: NEER'S IMPINGEMENT TESTS:-

Purpose of the Test- This test is designed to reproduce symptoms of rotator cuff impingement.

Test Position- Sitting or Standing

Performing the Test- In this, the examiner elevates the patients arm in internally rotated position. Pain is produced which will indicate overuse injury to the supraspinatus muscle or biceps tendon.

-: HAWKIN'S KENNEDY TEST:-

Purpose of the Test- For the presence of any impingement of the rotator cuff muscles

Test Position- Sitting or Standing

Performing the Test- The examiner places the patient's arm shoulder in 90 degrees of shoulder flexion with the elbow flexed to 90 degrees and then internally rotates the arm. The test is considered POSITIVE if the patient feels pain with internal rotation.

*To rule out the supraspinatus tendonitis cause of the impingement syndrome. We use EMPTY CAN TEST.

             In this, the patient is supposed to perform abduction in scapular plane with the thumb pointed downward. Such patient will have pain in the initial range of this movement.

*If the cause of impingement is involvement of biceps brachii. We use two tests:

 1.  SPEED'S TEST- The patient attempt to perform resisted elbow flexion and forward flexion of arm with supinated hand.

2. YERGASON'S TEST:- In this, resisted supination is performed with flexed elbow.

     

*The location of pain will also vary with both the above cases. In supraspinatus tendonitis, the patient will complain of pain above the spine of scapula upto the acromion.

While in bicipital tendonitis, the patient will complaint of pain upto the middle of arm.

*The strength of rotator cuff muscles is greatly reduced although the strengthening of scapula (serratus anterior, rhomboids, trapezius, latisimus dorsi) are unaffected.

*If the cause of impingement is calcium deposition. It will lead to tearing of rotator cuff muscles.

*In the presence of tear, instability of glenohumeral joint is present.

  

TREATMENT

The basic aim of the physiotherapy management is:-

 💧 to reduce pain

 💧 to improve extensibility of the thickened and contracted capsules of the joint.

 💧 to increase mobility of the shoulder

 💧 to improve strength of the muscles.

👉 To reduce pain- Electrotherapuetic modalities are used like U.S., IFT, TENS, LASER, CRYOTHERAPY, ETC.

👉 To increase mobility of the shoulder- When pain and effusion subsides, therapist can give mobilisation to the shoulder joint.

👉 To increase ROM- Active exercises upto pain free range ⇒ Active assisted exercises using WAND and PULLEY. 

👉 To improve strength of the muscles- Resisted exercises ( resistence should be increased in gradual manner.)