Maven Sports Medicine effectively combines our high standard of orthopedic rehabilitation practice with our clear understanding of elite fitness and sports performance. Maven’s Doctors of Physical Therapy have decades of combined practice experience in orthopedic rehabilitation, sports strength/conditioning, fitness, and athletic training. Our dedication to providing excellent evidence-based care to all our active and athletic patients remains consistent.

Subacromial

• Classification- primary or secondary. Primary impingement refers to degenerative processes that occur at the shoulder (subacromial space) as a result of microtrauma and acromial morphology (shape of the acromion) As a result, primary impingement often involves structures outside (extra-articular) of the glenohumeral joint itself. It typically affects the population over 50.
  
  
• D’Hespeel provides a clinical picture from his own experiences with this diagnosis- patients present with limited shoulder internal rotation (less than 50) and limited horizontal adduction as compared to the uninvolved side. Overall, primary impingement suggests a joint hypomobility issue as with most degenerative joint processes.
  
  
• Secondary shoulder impingement refers to instability at the glenohumeral joint (hence, a joint hypermobility issue). Typically, this type of impingement is often seen in the overhead athlete population.

Symptoms - pain typically occurs during mid to late range of shoulder abduction or with attempted overhead movements. The pain may be local to the shoulder region or radiate distally down the upper extremity during movement. Pain caused by impingement is often worsened or provoked by activity and made better by rest or avoidance of the provocative activty. "I can lift my arm up halfway, and then it starts to hurt," is often a remark made by patients with impingement syndrome.


Treatment

• Medical Intervention- Conservative medical intervention often includes a regiment of a three cortisones injection administered to the painful region over an interval of weeks to months apart in a given year or oral anti-inflammatories including Naprosyn, Ibuprofen, Mobic, to name a common few.
• Surgical Intervention- Acromioplasty may be recommended by a physician should conservative management fail and pain is debilitating enough to necessitate it. Acromioplasty is a type of surgery where a surgical burr is used to shave down portions of the acromion to increase space in the subacromial region.
• Physical therapy Intervention- Depending on many factors, the rehabilitation specialist can draw from several different modalities well supported by the literature- Posture re-education is a necessary foundation for shoulder rehabilitation. If the cause of pain is related to the forward head and rounded shoulder posture that seems to plague certain types of occupations (computer users, e.g.), then this slouching posture must be addressed immediately. We often have our patients simply practice pinching their shoulder blades together throughout the day. Remember, if it took a person 30 years to attain bad posture, every bit of activity and effort to counter the bad posture will be beneficial to their shoulder pain and to their rehab outcomes.
• Manual therapy- joint mobilization and soft tissue mobilization may be indicated. For a forward shoulder position, providing a posterior glide and/or inferior distraction of the humerus may be effective for aiding the head of the humerus in acquiring a more "centered" or at least more posterior position in the glenoid cavity. Soft tissue mobilization of tight upper trapezius and pectorals may also decrease the effect of dynamic elements on a forward shoulder position.
• Prognosis- As with many types of musculoskeletal pathology, when pain or symptoms related to shoulder impingement are addressed sooner than later, the prognosis is often good. However, impingement syndrome that is unaddressed and unchecked, may eventually lead to a rotator cuff tear, due to microtrauma occurring over time as the head of the humerus approximates the acromion.