Hooper's Beta Ep. 20

Intro:

In this episode we break down Shoulder Impingement Syndrome. We discuss some ways to test it yourself, symptoms you may experience, and some initial treatment to try. Be sure to read the show notes below for more details!

What is Shoulder Impingement Syndrome (SIS)?

SIS is any compression or impingement of structures around the glenohumeral joint that occur with shoulder elevation. This may be your: Subacromial Bursa, Supraspinatus, Subscapularis and/or Long head of biceps.

There are two main types of this, primary and secondary impingement.

Primary impingement is more anatomical. As in, the space is closed down due to an anatomical variation. The most common mophology is related to your acromion. We have three types: Type I - Flat, Type II - Curved, Type III - Hooked. If you have a hooked acromion, you are more prone to SIS.

Secondary impingement on the other hand is due to instability or biomechanical deficits causing the humerus to translate inappropriately into the subacromial space causing compression. Your shoulder is quite unstable. Think of a golf ball sitting on a tee rather than a deep ball and socket. It’s this way to make the shoulder so amazingly mobile. But that means it is susceptible to errors. So what are some common risk factors?

Risk factors may include:

• Repetitive activity at or above the shoulder (i.e. overhead sports)

• Instability of the shoulder which allows increased translation of the humeral head

• Scapular dyskinesia - alteration or deviation in the normal resting or active position of the scapula during shoulder movement

Often, SIS is a biomechanical issue. For complete overhead motion we need rotation of the humerus as well as of the scapula. If we are lacking either, the acromion, or the roof of the shoulder, doesn’t elevate, this causes a compression of the underlying structures.

So, if you are an overhead athlete with an unstable shoulder and scapular dyskinesis, you are at a greater risk.

What can you expect for symptoms?

• You may have pain with overhead activity localized to the deltoid area or lateral arm.

• May also have pain reaching behind.

• May have pain when lying on the shoulder

• Overtime pain may develop in the posterior shoulder or anterior shoulder.

But how do you know if you have this or something else?

The most important thing is to differentiate this from a rotator cuff (RTC) injury or tear.

Patients with a RTC tear may experience:

• Weakness in addition to pain

  • Weakness particularly of external rotation. See the "external rotation lag sign" test in the video.

• A drop arm sign

  • The drop arm sign is a test that tests the RTC. If you have a tear, you will be unable to lower your shoulder and rather it will drop. This may be protective (pain) or it may be solely due to inability (muscle tear).

Mechanism of injury is also important. A rotator cuff (RTC) tear may also be more trauma related whereas impingement can develop over time due to poor biomechanics.

So how do we test for impingement?

1. Painful arc: This test will typically present with a patient who has pain sometime between 60-12 degrees of abduction but can go through the full range of motion. They will have less pain from 0-60 and less pain from 120-180ish

2. Hawkins-Kennedy: This test specifically works to close down the subacrominal space. pain with this is common because you are closing space down so it is important to compare to your unaffected side to see if there is a distinct difference between the two sides.

3. Pain with external rotation: Unlike with a rotator cuff tear, where you may experience pain and weakness. With SIS, you would likely experience pain but not significant weakness with external rotation.

Fixing the cause:

Best advice: see a professional. It is hard to know exactly what your issue is. Is it a mobility issue? Stability issue? What if it is anatomical? A professional can help to identify your weakness (strength vs mobility) and develop a plan to help address it.

Also, check out our other videos on shoulder strengthening!

Top 6 Exercises for Rotator Cuffs - Strong Shoulders Pt. 1 - Hooper's Beta Ep. 11: https://youtu.be/qv9nQhyuKzk

For many overhead athletes (and all people, really) external rotator strength is an issue. Addressing this may be an easy solution!

Disclaimer:

As always, exercises are to be performed assuming your own risk and should not be done if you feel you are at risk for injury. See a medical professional if you have concerns before starting new exercises.

Written and Presented by Jason Hooper, PT, DPT, OCS, CAFS

IG: @hoopersbetaofficial

Filming and Editing by Emile Modesitt

www.emilemodesitt.com

IG: @emile166

Special thanks to The Wall for letting us film!

IG: @thewallclimbinggym