Shoulder pain at the front of the shoulder that occurs after gardening or any sort of manual work can be often be caused by impingement of the Supraspinatus tendon of the shoulder joint. The following is a typical case of Shoulder pain caused by Supraspinatus Impingement syndrome that I see on a weekly basis in my clinic.
Shoulder Pain Signs & Symptoms
Pain when doing overhead activity such as cleaning windows
Driving with affected hand on top of steering wheel causes shoulder pain
Sleeping on affected shoulder causes pain
Putting on a jacket or shirt or when reaching backwards with the arm aggravates shoulder pain.
Attempting to place the hand behind your back is quite painful
Shoulder pain is generally worse in the evening time after a hard day’s work
Symptoms are eased with rest, but re-occurs with activity.
Examination findings of Shoulder Pain
Winging of the shoulder blade of the painful shoulder meaning that the shoulder blade is angled to the front thus have an effect on the overlying acromion bone that overlays the affected shoulder joint.
The humeral head which is ball fitting into the socket of the glenoid fossa (see illustration), can tilt forward in an abnormal position inside of sitting in neutral thus compromising smooth movement at the shoulder joint and contributing to supraspinatus impingement.
Thirdly there will be weakness and pain on lifting the arm up from the hip in a sideways movement towards the ceiling, the patient will have difficulty achieving this full movement. The patient will also note pain on bringing the arm downwards towards the hip from an elevated position.
The patient’s shoulder pain is due to the supraspinatus tendon being impinged or compressed by the overlying acromion bone when the shoulder is being elevated. Shoulder blade winging and humeral head tilting implies that the muscles that move the shoulder blades backwards namely the serratus anterior and middle plus lower trapezius is weak. The forward tilting of the humeral head implies a weak stabilising relationship in the rotator cuff muscles that stabilise the shoulder joint. Treatment should initially target placing the scapula in a neutral position. When the Physical therapist holds this scapula in a neutral position the patient finds that their shoulder symptoms greatly subside. Hence exercises to achieve neutral shoulder blade position are very important. This is achieved by the Physical therapist taping the scapula into a neutral position so that the nerves that supply muscle control to the shoulder blade can learn this neutral painfree scapula position. Subsequent rehabilitation progressions involve strengthening the aforementioned mid shoulder blade muscles and an isometric strengthening focus on the probable weakened and inflammed rotator cuff.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy (MIAPT) and is based in Thurles.
Contact Number: 0504 26672
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Physiotherapy & Injury Rehabilitation Clinic in Tipperary