Physical Therapy for Shoulder Impingement & Tendonitis

Physical Therapy  for Shoulder Impingement & Tendonitis Blog

Almost all of us have shoulder pain sometimes. It can be difficult to determine what exactly is wrong, as your shoulder is a complex set of joints involving many muscles and tendons.

There are four muscles in your rotator cuff: subscapularis, teres minor,infraspinatus, and supraspinatus. These muscles connect to the scapula. and each has a tendon that ends at the humerus. This system resembles a sleeve around the humerus, hence the name.

The rotator cuff is prone to impingement. This is compression/irritation of one or more parts of the cuff. The compression usually is caused by the structure of your body or its response to irritation. When bursa or tendons in your shoulder sustain damage, become irritated, or are pinched, you may suffer pain and find it hard to move your arm. In this case, you may need to undergo physical therapy.

Not everyone can afford physical therapy, and there are some exercises you may be able to do at home. Preventing shoulder impingement as well as tendonitis, or at least reducing the risk, can be accomplished by regularly doing strengthening exercises and stretches for your shoulders. In addition, working this area can improve circulation and help you become more flexible. Here are a few exercises that can help out:

Rotate your arms externally

Stretching the upper shoulder regularly can strengthen it, which improves joint stability. To do this stretch, get two dumbbells. The weight you need will vary – you want a challenge, but not something that causes shoulder pain. To do this stretch:

  1.  Stand and hold a weight in each hand with your hands at your sides.
  2. Lock out elbows and raise your arms slowly until each arm makes an angle of 45 degrees with your torso.
  3.  Hold five seconds.
  4. Do three sets of 20 reps per day.

Scapular squeezes

This exercise is especially important for the subscapularis, or the muscle between the scapula and the ribcage. This is an excellent physical therapy exercise when done correctly, and it can also help prevent shoulder impingement, shoulder pain, and tendonitis. To sperform this useful exercise:

  1.  Lie with your back on the floor with knees bent. Your feet should be flat on the floor. Arms should be out so they are perpendicular to your torso.
  2. Keep your back flat and move your scapulas toward the center of your back and downward.
  3.  Hold five seconds.
  4.  Do one set with 20 reps a few times each day.

Triceps stretch

Keeping your triceps strong and flexible is an important part of shoulder strength and mobility. The triceps is often targeted in physical therapy for a variety of reasons; it can also help to reduce chances of shoulder pain. To do this stretch:

  1. Stand up and hold your right elbow above your head and your arm at a right angle.
  2. Push your elbow down by applying gentle pressure with your left hand.
  3. Hold five seconds.
  4. Do one set with ten reps each arm two or three times per day.

 

Shoulder injuries, including tendonitis, can be debilitating, and it’s important to be proactive in your exercises if you want to prevent injuries. If stretching while injured, be sure to avoid anything that causes pain. If you are a physical therapy patient, be sure to tell your therapist about any pain you experience. Intense stretching may make some injuries, like partial tears, much worse. If you are diligent about these exercises, you’ll be at less risk for shoulder pain, shoulder impingement, or tendonitis. The time investment is well worth the payoff.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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