Shoulder Impingement (Care of the Young Athlete)

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Shoulder impingement is an overuse injury that
causes achy pain on the front or side of the shoulder. The pain is felt most
when the arm is overhead or extended to the side. Shoulder impingement also is
called rotator cuff tendonitis, subacromial impingement, supraspinatus
tendonitis, and shoulder bursitis.

Shoulder impingement is common in swimmers and
athletes who play baseball, tennis, and volleyball. It can also occur in weight
lifters, gymnasts, divers, and rowers. Causes include a rapid increase in
overhead activity, weakness or strength imbalance in the rotator cuff or
scapular muscles, postural abnormalities, shoulder joint instability, or
improper training or technique.

The following is information from the American
Academy of Pediatrics summarizing treatment phases and goals for shoulder
impingement.

Phases and Goals of Shoulder Impingement Treatment

Treating shoulder impingement involves limiting
activities that cause pain and using ice and nonsteroidal anti-inflammatory
drugs (NSAIDs) to help reduce inflammation. The symptoms of shoulder impingement
will subside with rest, but the condition will not fully resolve until the
underlying causes have been identified and corrected.

Phase Goals Methods Comments
I
Pain control

1. Limit overhead activity
or anything that causes pain.

  • a.
    Pitchers—Limit pitching; may try playing
    first or second base.

  • b.
    TennisóLimit serves and overhead shots.

  • c.
    SwimmersóLimit butterfly, freestyle, and hand
    paddles.

2. Ice, NSAIDs.

1. The other phases of
rehabilitation will not be effective until pain is
controlled.

2. Swelling inside the
shoulder may worsen the pain and contribute to further
injury.

3. Pain may be reduced by
limiting activities or changing technique for painful
activities.

II


Therapeutic exercise

1. Correct poor posture.

2. Restore strength to
scapular stabilizers.

1. Stretch anterior chest
wall muscles; strengthen inter-scapular muscles with
rowing-type exercises (Figure 1), and strengthen scapular
stabilizers with shoulder protraction exercises (Figure
2).

2. Use elastic tubing or
weights to strengthen external rotators of shoulder.

Proper posture is very importantóchest out and shoulders
back. These exercises strengthen parts of the body that help
with posture and holding the shoulder bones in the proper
position.
III
Maintain fitness; strengthen related areas

1. Continue with aspects of
the sport that don’t require overhead motion or cause
pain.

2. General conditioning,
including aerobic exercise (running, cycling, kicking drills
for swimmers).

3. Lower extremity and trunk
strengthening.

Strength in the legs, hips, and trunk is crucial for maximizing
arm strength and power with throwing or tennis. This part of
rehabilitation can usually take place while shoulder pain is
subsiding.
IV
Restore function

1. Resume overhead motion
gradually as symptoms permit.

2. Correct technique or
training.

1. For pitchers, follow a
graded return-to-throwing program.

2. Consider biomechanical
assessment if technique errors are suspected in a pitcher,
swimmer, or tennis player.

V
Maintenance therapy; prevent recurrent
injury

Continue with maintenance exercises that have been prescribed
and any corrections in technique or training regimens that
helped with recovery. Include exercises that help prevent the
strength imbalances that occur with repetitive overhead activity
and contribute to injury.
Athletes should continue select important exercises after
therapy. These are typically not as extensive or time-consuming
as the rehabilitation program.