‘Shoulder Pain during Tennis & Swimming – Internal Impingement’
The chronic Shoulder condition known as Internal Impingement Syndrome is a common aggravating problem for Tennis players, Swimmers and occupations such as Plasterers and Painters. The injury occurs gradually and is caused by overhead activity such as hitting a ball overhead with a tennis racquet. It can also occur during repetitive painting and plastering of ceilings. If we picture the shoulder joint as a ball fitted into a socket with rotator cuff tendons that help stabilise and move this ball known as the humeral head in its socket namely the glenoid fossa. Internal Impingement occurs when the rotator cuff tendons become pinched between the humeral head glenoid fossa during overhead head force movement of the arm. The constant pinching of the Infraspinatus ans Supraspinatus tendons during overhead activity leads to irritation of both these tendons bring about tendinopathy and pain with movement.
Symptoms of Internal Impingement
Pain in the area behind the Shoulder during overhead sporting activity
Tender to palpate or press the muscle tissue at the back of the shoulder (infraspinatus tendon)
Weakness when swinging the arm overhead such as when a tennis player is attempting to serve a ball overhead or when a swimmer is attempting an overhead stroke.
Difficultly bringing arm behind your lower back
Long term chronic shoulder injury in Sport.
Causes of Internal Impingement
Underlying dysfunctions are linked to the onset of Internal Shoulder Impingement. Firstly restricted Internal Rotation movement of the shoulder which can be seen when a person finds it difficult to place their hand behind their lower back. This is due to tightness at the back of the shoulder joint, namely the Posterior Joint Capsule & the Infraspinatus rotator cuff tendon. This tightness and restriction of the joint capsule, infraspintus and Inferior Glenohumeral Ligament of the shoulder causes the humeral head to move at an abnormal angle against the socket of the glenoid fossa during the cocking phase of throwing which is when the arm is held overhead. Secondly there is anterior or frontal shoulder joint instability meaning that when the shoulder is tested in clinic there is excessive forward movement of the humeral head away from the socket suggesting a loose front joint capsule. The third dysfunction is lack of strength of muscles between shoulder blades.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy and is based in Thurles. Contact Number: 0504 26672 Email: email@example.com