|
The Shoulder Impingement Syndrome Part 2
By: Dr. Cherif Tadros, Orthopaedic surgeon, Kinatex Jarry
Treatment
Once the diagnostic of the impingement syndrome is established, the appropriate treatment must be administered. NSAI are helpful to ease the pain and are often combined a therapeutic program.
As for rehabilitation, we recommend a program specific to the impingement syndrome, which includes 5 parts:
 |
1 – Avoid painful movement – photo 5
It is logical to think that an irritated tendon must rest. We recommend patients to avoid painful movements for a few weeks (work above shoulder height, tennis service, filing, etc.) |
 |
2 – Stretching of the posterior capsule – photo 6
Patients suffering from impingement also often suffer from a contracture of the shoulder posterior capsule. We teach patients a stretching program, which aims at gaining back the full range of motion of the joint, an essential condition to recover shoulder normal function. |
  |
3 – Muscle strengthening – photos 7 and 8
Once the range of motion is back to normal, we then do strengthening exercises. In order to reduce impingement, we aim especially at the internal and external rotators, which are stabilizing muscles of the shoulder. |
 |
4 – Aerobics
Patients suffering from shoulder pathology are often depressed and in poor shape. They are gaining weight and doing little physical activity.
Therefore, we recommend a daily aerobics program of about 30 to 40 minutes in order to reach a heart rhythm of 120 beats per minute (photo no 9). This exercising improves shape, increases the pain threshold and stimulates the endorphin secretion, which makes patients feel good. |
 |
5 – Work or sport change
The objective of the program described above is to make sure that the patient goes back to his or her occupation or sport.
At times, the work or sport position must be examined and modified if possible. For instance, it is easy to ask a secretary to lift up her seat to avoid the horizontal positioning of the shoulders while typing or to modify the service technique of a tennis player.
In case of a failure of conservative treatment, people having jobs requiring intense and repetitive movements above shoulder height may benefit from a career reorientation.
|
We would rather “modify the work before modifying the acromion”.
This program lasts 6 weeks. If no improvement is noticed after this period of time, an infiltration of corticosteroids in the subacromial space may be attempted often with satisfying results.
A tear of the cuff ought to be eliminated through an appropriate X-Ray appraisal. If the investigation is negative, we keep on doing the conservative treatment during 6 months before thinking about a surgery of the acromion.
This intervention, which is the thinning of the acromion, may be done through open surgery, but the current trend is to do it through arthroscopy, which give excellent results.
If the investigation reveals a tear of the cuff, we discuss with the patient a surgery of the acromion followed by a cuff repair.
In conclusion, the impingement syndrome is a common pathology that can be treated very satisfyingly if the appropriate diagnose is given and if a good therapeutic protocol is well established and respected.
|
|
|
|
 |
 |
| May 8 2008 |
Golf
Whether you are beginner or a talented player, golf remains a challenging sport for all, where achievements are all relative, are often the result of a good physical preparation. |
More information |
 |
| January 10 2008 |
Blackberry Thumb and repetitive strain injuries
Office-related repetitive strain injuries have taken on a new twist. |
| More information |
|
Consult previous articles |
| |
|
|
|
|
|
