Nonoperative Management of Secondary Shoulder Impingement Syndrome

Kamkar, Abdulazeem; Irrgang, James J.; Whitney, Susan L.

doi:10.2519/jospt.1993.17.5.212

Cited by 169 publications

(108 citation statements)

References 19 publications

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“…15,16 Regardless of the initial etiology, inflammation in the suprahumeral space, inhibition of the rotator cuff muscles, damage to the rotator cuff tendons, and altered kinematics are believed to exacerbate the condition. 1,17 Impingement is thought to be due to inadequate space for clearance of the rotator cuff tendons as the arm is elevated. 1,10,15 Therefore, factors that further minimize this space are believed to be detrimental to the condition.…”

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confidence: 99%

“…15,[17][18][19] Motions that bring the greater tuberosity in closer contact with the coracoacromial arch 20 are particularly problematic. These motions include excessive superior or anterior translations of the humeral head on the glenoid fossa, inadequate lateral (external) rotation of the humerus, and decreases in the normal scapular upward rotation and posterior tipping on the thorax, all occurring during humeral elevation.…”

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confidence: 99%

“…15,[17][18][19][20] Additionally, the hypothesized kinematic alterations in scapular motion have been linked to decreases in serratus anterior muscle activity, increases in upper trapezius muscle activity, or an imbalance of forces between the upper and lower parts of the trapezius muscle. 17,19,21 Evidence to support the existence of abnormal electromyographic (EMG) or kinematic patterns in people with shoulder pain is limited. Investigations of altered scapulothoracic EMG patterns in patient populations have been nonspecific regarding subject diagnoses or restricted to testing of athletic activities.…”

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confidence: 99%

“…16,17,19,29 -31 In particular, the muscular control of the scapula has become a recent focus of therapeutic intervention. 17,19 Due to limited scientific data from which to design exercise programs, these programs often vary widely. 16,17,19,30,31 Although previous investigations have provided important contributions, they are often constrained by static analysis, 25,27 2-D analysis, 25,26 varied patient diagnoses, 24,25 a lack of control for exposure to overhead activity between subjects with and without symptoms of impingement, 24 -28 small sample sizes, 22,25,26,28 or other methodologic limitations.…”

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confidence: 99%

“…17,19 Due to limited scientific data from which to design exercise programs, these programs often vary widely. 16,17,19,30,31 Although previous investigations have provided important contributions, they are often constrained by static analysis, 25,27 2-D analysis, 25,26 varied patient diagnoses, 24,25 a lack of control for exposure to overhead activity between subjects with and without symptoms of impingement, 24 -28 small sample sizes, 22,25,26,28 or other methodologic limitations. [22][23][24]28 The purpose of our study was to provide a 3-D analysis of both glenohumeral and scapulothoracic kinematics and associated scapulothoracic muscle activity in subjects with symptoms of shoulder impingement relative to subjects without shoulder impairment who were matched for occupational exposure to overhead work.…”

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Alterations in Shoulder Kinematics and Associated Muscle Activity in People With Symptoms of Shoulder Impingement

2000

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Background and Purpose. Treatment of patients with impingement symptoms commonly includes exercises intended to restore "normal" movement patterns. Evidence that indicates the existence of abnormal patterns in people with shoulder pain is limited. The purpose of this investigation was to analyze glenohumeral and scapulothoracic kinematics and associated scapulothoracic muscle activity in a group of subjects with symptoms of shoulder impingement relative to a group of subjects without symptoms of shoulder impingement matched for occupational exposure to overhead work. Subjects. Fifty-two subjects were recruited from a population of construction workers with routine exposure to overhead work. Methods. Surface electromyographic data were collected from the upper and lower parts of the trapezius muscle and from the serratus anterior muscle. Electromagnetic sensors simultaneously tracked 3-dimensional motion of the trunk, scapula, and humerus during humeral elevation in the scapular plane in 3 handheld load conditions: (1) no load, (2) 2.3-kg load, and (3) 4.6-kg load. An analysis of variance model was used to test for group and load effects for 3 phases of motion (31°-60°, 61°-90°, and 91°-120°). Results. Relative to the group without impingement, the group with impingement showed decreased scapular upward rotation at the end of the first of the 3 phases of interest, increased anterior tipping at the end of the third phase of interest, and increased scapular medial rotation under the load conditions. At the same time, upper and lower trapezius muscle electromyographic activity increased in the group with impingement as compared with the group without impingement in the final 2 phases, although the upper trapezius muscle changes were apparent only during the 4.6-kg load condition. The serratus anterior muscle demonstrated decreased activity in the group with impingement across all loads and phases. Conclusion and Discussion. Scapular tipping (rotation about a medial to lateral axis) and serratus anterior muscle function are important to consider in the rehabilitation of patients with symptoms of shoulder impingement related to occupational exposure to overhead work. [Ludewig PM, Cook TM. Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Phys Ther. 2000;80:276 -291.]

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confidence: 99%

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Alterations in Shoulder Kinematics and Associated Muscle Activity in People With Symptoms of Shoulder Impingement

2000

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Shoulder Injuries in Sport

Horsley

2010

Sports Rehabilitation and Injury Prevention

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Force steadiness, muscle activity, and maximal muscle strength in subjects with subacromial impingement syndrome

et al. 2006

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We investigated the effects of the subacromial impingement syndrome (SIS) on shoulder sensory-motor control and maximal shoulder muscle strength. It was hypothesized that both would be impaired due to chronic shoulder pain associated with the syndrome. Nine subjects with unilateral SIS who remained physically active in spite of shoulder pain and nine healthy matched controls were examined to determine isometric and isokinetic submaximal shoulder-abduction force steadiness at target forces corresponding to 20%, 27.5%, and 35% of the maximal shoulder abductor torque, and maximal shoulder muscle strength (MVC). Electromyographic (EMG) activity was assessed using surface and intramuscular recordings from eight shoulder muscles. Force steadiness was impaired in SIS subjects during concentric contractions at the highest target force level only, with muscle activity largely unaffected. No between-group differences in shoulder MVC were observed. The present data suggest that shoulder sensory-motor control is only mildly impaired in subjects with SIS who are able to continue with upper body physical activity in spite of shoulder pain. Thus, physical activity should be continued by patients with SIS, if possible, to avoid the loss in neural and muscle functions associated with inactivity.

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Nonoperative Management of Secondary Shoulder Impingement Syndrome

Cited by 169 publications

References 19 publications

Alterations in Shoulder Kinematics and Associated Muscle Activity in People With Symptoms of Shoulder Impingement

Alterations in Shoulder Kinematics and Associated Muscle Activity in People With Symptoms of Shoulder Impingement

Shoulder Injuries in Sport

Force steadiness, muscle activity, and maximal muscle strength in subjects with subacromial impingement syndrome

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