Shoulder Impingement: Defining and Treating

hurt-shoulder-HamptonPTBy Kristin Keafer DeRousse, PT, DPT – Hampton Physical Therapy, Hampton, NH clinic

What is Shoulder impingement?

Shoulder impingement syndrome is the most common musculoskeletal diagnosis related to shoulder injuries. There has been an ongoing debate on the etiology of impingement and rotator cuff tears, but it is likely to be multifactorial(4). Impingement indicates that there is a narrowed space underneath the acromion (see diagram 1). Structures that may be involved in this diagnosis include the rotator cuff tendons, bicep tendon, subacromial bursa, and the coracoacromial ligament. Sometimes bone spurs develop within this space and cause inflammation to these structures, however other times there may be evidence of degenerative “wear and tear” of the rotator cuff tendon that is causing the pain.

The shoulder is a multidirectional joint and therefore the assessment of the joint capsule, scapular movement patterns, and shoulder muscles should be performed to determine the extent to each individual injury. A clinical examination and movement-based assessment should be used to determine the reason for underlying pain and inflammation.

Signs and symptoms
If inflammation exists within the subacromial space, the mechanics of the shoulder brakes down causing pain and movement dysfunction. This will typically result in anterolateral arm pain. Common exacerbating movements include laying on the affected side, stretching and reaching for overhead objects. A painful arc will be present when raising the arm between 60 and 120 degrees.

Rotator cuff anatomy
More than likely you will have involvement of the rotator cuff tendons. There are 4 muscles part of the rotator cuff: supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles are responsible for stabilizing and gliding the shoulder properly when you move and raise your arm away from your body. The most common rotator cuff muscle involved is the supraspinatus since it travels directly under the acromion. Pain, inflammation, and weakness at any of these muscles will decrease the ability to raise your arm overhead.

rotator-cuff---HPTTreatment
Research indicates that conservative treatment methods are the most effective if you do not have a full thickness tear of the rotator cuff. Physical therapy is a critical component to your recovery of shoulder impingement and rotator cuff tendon injuries.

shoulder-therapySupervised exercise that includes range of motion activities, stretching, and strengthening is imperative in the rehabilitation process (2). Research also indicates that manual therapy in addition to exercise is better than just exercise alone (1). This may include joint mobilization to address the joint capsule as well as soft tissue mobilization techniques to address pain and muscular dysfunction. There is also research to support the use of cervical and thoracic manipulation to reduce pain and improve range of motion through the shoulder(5). All of our therapists are well trained in these manual techniques.

Corticosteroids are also commonly used as an avenue for conservative treatment by physicians. However, research indicates that these patients require additional doctors visits and multiple steroid injections as compared to those patients who receive physical therapy alone (3). Many times patients that receive injections require physical therapy additionally anyways.

Surgical intervention is not recommended unless there is a large rotator cuff tear and is most always the last resort as a treatment option.

Recommendations
Physical therapy should be the initial step to treating shoulder impingement and rotator cuff pathology. This ultimately allows for reduced healthcare costs and provides a conservative effective avenue for returning patients to their daily activities without pain.

Direct access allows for many patients to come directly to physical therapy without a physician referral to evaluate and treat a musculoskeletal dysfunction. If you have a pain in your shoulder, please call Hampton Physical Therapy with clinics in both Hampton, NH and Seabrook, NH to schedule a comprehensive assessment!

References

1. Bang, MD, et al. Comparison of Supervised Exercise With and Without Manual Physical Therapy for Patients With Shoulder Impingement Syndrome. J Orthop Sports Phys Ther 2000;30:126–137.

2. Halk, MN, et al. Effectiveness of physical therapy treatment of clearly defined subacromial pain: a systematic review of randomised controlled trials. Br J Sports Med. 2016 Sep;50(18):1124-34.

3. Rhon, DI, et al. One-Year Outcome of Subacromial Corticosteroid Injection Compared With Manual Physical Therapy for the Management of the Unilateral Shoulder Impingement Syndrome: A Pragmatic Randomized Trial. Ann Intern Med. 2014;161(3):161-169.

4. Singh, B, et al. Current Concepts in the Diagnosis and Treatment of Shoulder Impingement. Indian J Orthop. 2017 Sep-Oct; 51(5): 516–523.

5. Vinuesa-Montoya, S, et al. A Preliminary Randomized Clinical Trial on the Effect of Cervicothoracic Manipulation Plus Supervised Exercises vs a Home Exercise Program for the Treatment of Shoulder Impingement. J Chiropr Med. 2017 Jun;16(2):85-93.

Have a Pain in Your Head?

Types of Headaches and How They Can Be Helped…

headache cure HPT

by Michael Brezak, PT, DPT – Hampton NH Clinic

We all live stressful lives. The hustle and bustle of day to day activities at times can leave us feeling a bit stretched too thin. Stress plays an important role in how we feel and interact with our friends, family, and colleagues. Leaving stress to become so ‘built up’ as it were can lead to further medical complications including headaches. It is estimated that about 80% of all individuals have experienced some form of a headache in one way or another(1). It is about understanding your symptoms to find the best treatment for your condition. This article will go over three different types of headaches (Tension, Migraine, and Cervicogenic) and then see how Hampton Physical Therapy can help.

Tension headaches are the most common and usually the type that affects the majority of the population on a day to day basis(1). It is that constant “pounding” sensation that one may experience along their temple or even in the back of the neck. This type of headache typically is the result of increased stress which can cause tightened muscles at the base of the neck. Largely these can be managed with over the counter medication, ice, and reducing stress levels all are effective management techniques to reducing your symptoms.

“Migraine headaches have controlled my life for years now. After trying just about every medicine available, I have found the best way to keep the migraines under control to be dry needling therapy. Kate and the team at Hampton Physical Therapy are great!” Ginny Carr

Next are migraine headaches which can often times be debilitating in terms of severity or longevity. Migraine headaches can be attributed to certain ‘triggers’ that develop over time, but largely their exact cause is unknown(2). The more common triggers include light sensitivity, noise levels, and even changes in the weather. These type of headaches are usually precipitated in the form of an ‘aura’ which foreshadowing of impending symptoms.
cervogenic headache
Lastly are cervicogenic headaches which can often times be confused with tension headaches are their presentation is similar. These types of headaches present with decreased range of motion in the neck and joint pain ranging from the shoulders to the base of the skull(3). One aspect of these type of headaches is even a joint dysfunction of the spinal column can be the underlying cause(4). An interesting specific feature of this type of headache is that they are usually one sided in origin(5). Meaning that its presentation is one where it feels as if it radiates from the base of the neck and wraps around in a crescent pattern towards the eye.

In the end, it truly depends on what type of headache you have and how to find the right treatment. A thorough evaluation by a primary physician or a physical therapist can be the first step in the right direction. Each therapist at Hampton Physical Therapy is trained in various techniques including the latest research based treatment of cervical manipulation (similar to chiropractors) and Trigger Point Dry Needling to reduce or eliminate headaches and related symptoms.

 

Fall Prevention Strategies in the Home

Louish-Pixel---tripping

By Katherine Younes, DPT – Hampton Clinic

Did you know according to the National Institute on Aging Senior Health 6 out of every 10 falls happen at home?2 This means the one place where seniors feel safe can actually be hazardous to their health. Hampton Physical Therapy wants to share that whether your loved one lives in their own home or with you, there are some easy ways to prevent falls at home which are the leading cause of fatal and non-fatal injuries for older Americans.1

Here are 7 of the best ways to prevent falls at home and keep your loved one safe.

Remove all fall hazards in the home: Remove throw rugs, frayed carpets, small furniture like plant and magazine stands,and piles of clutter. 2 Move pet bowls to a corner. Tuck electrical and phone cords into cord organizers that keep them out of traffic paths. Make sure that wet boots and shoes can be removed before making the floors inside the house slippery.

Provide wide walkways in the home: Squeezing through tight spaces can cause a senior to lose balance and fall. Make sure that the traffic patterns in the home are wide and free of clutter. This is important whether or not your loved one relies on a cane or walker. Aging can reduce vision and depth perception and that is why a clear, wide path is essential.

Remove trip hazards: Tablecloths are pretty but if the corners drag on the floor it can become a trip hazard. Toys are especially dangerous, whether they are children’s toys or pet toys.

Make the bathroom safe: Use non-slip bath mats that are a contrasting color from the tub. 2 This will make it safe and easy to see. Place handrails beside the tub and toilet and purchase a raised toilet seat. All of these will help to improve your loved one’s balance in a potentially slippery environment.

Maximize lighting: All light fixtures inside and outside should have bulbs with the maximum wattage allowed. 2 Make sure that they are positioned to eliminate shadows. Make sure that lights near the bed are within easy reach to avoid falling out of bed. Use nightlights in the bedrooms, bathrooms and hallways. Place a flashlight next to the bed in case the power goes out. 2

Arrange the house for convenience and safety: Ask your loved one to show you where he or she sits to watch TV and the location of frequently used dishes, pots and pans. Ask where he or she likes to read. In this way you can see where trip and fall hazards might occur and adjust the location of things to make them safer. For example, a throw rug should not be at the front door. Your loved one should not have to reach to a high shelf to get glasses or dishes, they should be on a lower shelf that is within easy reach.

Prepare the outdoors for safety. The exterior of the house can be especially hazardous and create falls. Make sure that the walkways are even and don’t have cracked pavement or uneven bricks. In the winter make sure that ice and snow is completely removed and that sand or salt is generously spread on icy surfaces. Make sure that stairs are well lit, the edges are marked with contrasting tape and that they are painted with non-slip paint. If you have fallen and need assistance call 911 – then call us at Hampton Physical Therapy (603) 929-2880 and we’ll get you back to your everyday best! Www..HamptonPT.com

These thorough yet simple fixes can help to prevent falls at home and keep your loved one safe. Falls, with or without injury, are one of the reasons older adults limit their activity and how often they leave their home.1

If you have fallen and need assistance call 911 – then call us at Hampton Physical Therapy (603) 929-2880 and we’ll get you back to your everyday best! www..HamptonPT.com

Resources  

1 Falls Prevention Facts. NCOA. 2017. Available at: https://www.ncoa.org/news/resources-for-reporters/get-the-facts/falls-prevention-facts/. Accessed April 1, 2017.

2 NIHSeniorHealth: Falls and Older Adults – Fall Proofing Your Home. Nihseniorhealthgov. 2017. Available at: https://nihseniorhealth.gov/falls/homesafety/01.html. Accessed April 1, 2017

Photo by Louish Pixel – https://www.flickr.com/photos/louish/