What is Impingement syndrome?
Chiropractic treatment for sub-acromial bursitis (or shoulder bursitis) and rotator cuff tendonitis is very effective. These are two conditions that often occur simultaneously. There is inflammation of a particular area within the shoulder joint that is causing a common set of symptoms. The best terminology for these symptoms is ‘impingement syndrome.’ Impingement syndrome occurs when there is inflammation of the rotator cuff tendons and the bursa that surrounds these tendons.
Where is the problem that causes shoulder bursitis?
Impingement syndrome, or shoulder bursitis, occurs when there is inflammation between the top of the humerus (arm bone) and the acromion (tip of the shoulder). Between these bones lies the tendons of the rotator cuff muscles, and the bursa that protects these tendons. The muscles affected are the teres minor, infra spinatus and supra spinatus. Normally, these tendons slide effortlessly within this space.
What causes this problem?
The most common cause is a combination of overuse and faulty mechanics of the shoulder, which is often caused by a muscle imbalance. If the upper trapezius muscle is hyperactive and the scapular stabilising muscles and the rotator cuff are weak, it prevents the shoulder from moving normally and causes impingement. The postural changes often seen in association with this muscle imbalance would be rounded and forward drawn shoulders, and a head-forward posture.
The problem can be exacerbated by wear and tear of the A/C joint and thickening of the rotator cuff tendon. In some individuals with this problem, the shape of their bones is such that they have less space than normal. Therefore, only slight thickenings of the tendons or bursa can cause symptoms. Often there is an initial injury, either due to trauma or overuse that sets off the process of inflammation. Thereafter, the problem can be self-exacerbating. Once there is an initial injury, the tendons and bursa become inflamed. This inflammation causes a thickening of these structures due to fibrosis and scar-tissue build-up. The thickening then takes up more space, and therefore the tendons and bursa are pinched upon even more – this is the impingement. This causes more inflammation, and more thickening of the tendons and bursa, and so on. This can lead to a chronic condition, therefore early treatment is very important.
What are the symptoms of shoulder bursitis / impingement syndrome? Common symptoms include:
•Pain with lifting the arm out away from your body and up (abduction), activities above shoulder height. The painful arc is between 80-120°.
•Pain while sleeping at night
•Pain over the outside of the shoulder/upper arm
Impingement syndrome and a rotator cuff tear are different problems, and although they are related, the treatment is different. Impingement syndrome is a problem of inflammation around the rotator cuff tendons. A rotator cuff tear is an actual tear within the tendons. The best sign that differentiate these problems is the strength of the rotator cuff muscles. Dr. J will be able to specifically isolate these muscles to better determine if a rotator cuff tear is present. Once the problem has been diagnosed the chiropractor can start to give advise and start the treatment.