In my ten years of chiropractic practice I have seen a multitude of patients with impingement syndrome an adhesive capsulitis. These conditions don’t just happen overnight. Many times they start as bursitis that goes ignored and untreated. Get educated and get treatment.
Subacromial bursitis is a condition caused by inflammation of the bursa that separates the top surface of the supraspinatus tendon (one of the four tendons of the rotator cuff) from the overlying ligaments, the scapula (shoulder blade) and from the bottom surface of the deltoid muscle. The subacromial bursa helps the motion of the supraspinatus tendon of the rotator cuff in activities such as overhead work. Inflammatory bursitis is usually the result of repetitive injury to the bursa. In the subacromial bursa, this generally occurs due to microtrauma to near by structures, particularly the supraspinatus tendon. The inflammatory process causes increased fluid production within the bursa and reduction in the outside layer of lubrication. The bursa facilitates the motion of the rotator cuff beneath the boney structures of the scapula, any disturbance of the relationship of the subacromial structures can lead to impingement. These factors can be broadly classified as intrinsic such as tendon degeneration, rotator cuff muscle weakness and over -use. Extrinsic factors include bone spurs from the acromion or A-C joint, shoulder instability and neurologic problems arising outside of the shoulder. Subacromial bursitis often presents with a combination of symptoms called impingement syndrome.
Pain along the front and side of the shoulder is the most common symptom and may cause weakness and stiffness. If the pain resolves and weakness persists other causes should be evaluated such as a tear of the rotator cuff or a neurological problem arising from the neck or entrapment of the suprascapular nerve. The onset of pain may be sudden or gradual and may or may not be related to trauma. Impingement may be brought on by sports activities, such as overhead throwing sports and swimming, or overhead work such as painting, carpentry or plumbing or slicing meat at the deli. Activities that involve repetitive overhead activity, or directly in front, may cause shoulder pain. Direct upward pressure on the shoulder, such as leaning on an elbow may increase pain. Night time pain, especially sleeping on the affected shoulder, is often reported. Localized redness or swelling are less common and suggest an infected subacromial bursa. In patients who are less than forty years old, the diagnosis of impingement syndrome should be viewed with caution because these patients may have subtle glenohumeral instability.
Many non-operative treatments have been advocated, including Chiropractic manual therapy; and local modalities such as cryotherapy, ultrasound, electrophysical modalities.
Shoulder bursitis rarely requires surgical intervention. Surgery is reserved for patients who fail to respond to non-operative measures.
Goals for treatment:
Reduce inflammation; reduce pain, prevent weakness and atrophy of muscles as a result of disuse, prevent/reduce impingement and further tissue damage. Educate the patient about their condition and advise to avoid painful activities and the importance of relative rest of the shoulder prevention of pain and impingement which delays the healing process.
Treatment:
Chiropractic manual therapy
Electrophysical modalities and Ice
Low intensity pulsed ultrasound (3 Hz)
May use head of humerus repositioning tape, such as Kinesio tape.
Justification: Has a neurophysiological affect reducing pain and improving synovial fluid flow, improving healing. Promotes correct posture and puts muscles in the optimal length tension relationship, reducing impingement. Centers humeral head and facilitates adequate muscle timing and recruitment.
To reduce inflammation and pain and facilitate healing.
To maintain the head of humerus in its central position for optimal muscle recruitment
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