Good Shoulder Impingement Research Paper Example

INTRODUCTION

Shoulder impingement is one of the commonest causes of shoulder pain seen in the persons who repeatedly use their shoulders for their work, as for example, weight lifters, painters, swimmers and all other professions where the weight needs to be lifted above the level of the head (Webmd.com, 2015). The prevalence rate of shoulder impingement is quite high, ranging from 30% people experiencing it at least once in a life time up to 50% who experience the same annually (Lewis, 2009). In this condition the tissues and tendons of the rotator cuff are inflamed or compressed by the surrounding structures. If the condition continues to be prolonged or chronic, it may lead to structural damages also. The condition can be divided in to three stages, each stage affecting a particular age group.

The stages are:

Stage 1: Seen in people younger than 25 years of age. Commonly presenting with pain and swelling.
Stage 2: Seen in the age group 25- 40 years. They manifest weakness of the tendons, hence also called as tendinopathy.
Stage 3: Seen in patients above the age of 40. Common manifestations are rotator cuff tear, tendon rupture and/ or changes in the bones or shoulder (Bryan Dixon, 2015).

ANATOMY

The term shoulder impingement is used to describe any injury to the rotator cuff or the shoulder muscles. As it is basically related to the tendons of the rotator cuff, it is also called as Rotator cuff tendinitis. The shoulder consists of three bones mainly, humerus or the bone of the upper arm, clavicle or the collar bone and the scapula or the shoulder blade. These three bones together form the rotator cuff. The name is given so because this joint of the body can be rotated easily all along (Orthoinfo.aaos.org, 2015). There are four muscles in the rotator cuff namely, teres minor, suprasupinatus, infrasupinatus and subscapularis. The tendons attaching these muscles to the bones join together to form a cuff. All these muscles have a common insertion, that is, the scapula. At times the injury occurs at the bursa, bursa is a soft material that allows easy movement of the ball and socket joint of the shoulder. Any injury to this bursa will also lead to similar manifestation. However, then the problem will be termed as bursitis instead of tendinitis.

INJURY EVALUATION

SIGNS
Neer test: This is carried out by the physician in the clinical setting. The structures that this test examines are the infraspinatus tendon, supraspinatus tendon and long head of biceps tendon. The patient is made to relax properly. The arm to be tested is kept at rest with the elbow fully extended and kept at the side of the body. The doctor then passively moves the arm. He will first make an internal rotator movement followed by forceful forward flexion till the patient reports about pain. The test is said to be positive if during conduction of the test pain is felt in the antero lateral aspect of the shoulder. This test is believed to be one of the best tests to determine the injury of the rotator cuff. Although Hawkins-Kennedy test equally holds equal value in diagnosing shoulder impingement, still Neer test seems to be more reliable. (Physical Therapy Web, 2015).
Hawkins-Kennedy test: This test is used to determine the impingement of the supraspinatus tendon. This test is conducted by the physician with the patient standing in front of him. He will first flex the patient’s arm to 90 degrees and then forcibly rotate it medially. The appearance of pain during the test will be taken as positive result (Physical Therapy Haven, 2015).
Empty can/full can test: This test examines the strength of the supraspinatus miscle. As the name suggests, the patient is asked to perform the actions of emptying or filling a can. Pain elicited would mean a positive result (Moses, 2015).

SYMPTOMS

The pain of shoulder impingement develops gradually in to a severe form. Initially the pain will be felt at the side and front of the shoulder while lifting weight above the level of the head in actions like swimming, painting etc. With time the pain will extend to the back of the shoulder during abduction or external rotation of the arm. The pain will be most prominently felt when lifting any weight up to 90 degrees against any resistance (Sportsinjuryclinic.net, 2015).

DIAGNOSIS

The condition can be diagnosed by clinical findings. The tests performed can be used for diagnostic purpose.
X- ray: X- ray needs to be done to exclude arthritis or any other grave injury. It can be helpful in determining if there is any fracture which is being mistaken as shoulder impingement.
Ultrasound: Ultrasound can be required in very rare cases to diagnose any rupture in the tendons.

References

Bryan Dixon, J. (2015). Shoulder impingement syndrome. Uptodate.com. Retrieved 11 March 2015, from http://www.uptodate.com/contents/shoulder-impingement-syndrome-beyond-the-basics
Lewis, J. (2009). Rotator cuff tendinopathy/subacromial impingement syndrome: is it time for a new method of assessment?. British Journal Of Sports Medicine, 43(4), 259-264. doi:10.1136/bjsm.2008.052183
Moses, S. (2015). Supraspinatus Test. Fpnotebook.com. Retrieved 11 March 2015, from http://www.fpnotebook.com/Ortho/Exam/SprspntsTst.htm
Orthoinfo.aaos.org,. (2015). Shoulder Impingement/Rotator Cuff Tendinitis-OrthoInfo - AAOS. Retrieved 11 March 2015, from http://orthoinfo.aaos.org/topic.cfm?topic=a00032
Physical Therapy Haven,. (2015). Hawkins-Kennedy Test. Retrieved 11 March 2015, from http://www.pthaven.com/page/show/157385-hawkins-kennedy-test
Physical Therapy Web,. (2015). Neer Test - Orthopedic Shoulder Examination - Physical Therapy Web. Retrieved 11 March 2015, from http://physicaltherapyweb.com/neer-test-orthopedic-shoulder-examination/
Sportsinjuryclinic.net,. (2015). Shoulder Impingement Syndrome. Retrieved 11 March 2015, from http://www.sportsinjuryclinic.net/sport-injuries/shoulder-pain/impingement-syndrome-shoulder
Webmd.com,. (2015). Shoulder Impingement Syndrome: Symptoms, Treatments, Causes, and More. Retrieved 11 March 2015, from http://www.webmd.com/osteoarthritis/guide/impingement-syndrome