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- Conservative treatment measures are often very successful
in alleviating your pain and symptoms.
The cornerstone of treatment for shoulder impingement
is physical therapy.
Therapy is used to increase your range of motion,
increase your strength,
and thus, decrease your impingement symptoms.
Anti-inflammatory medications are an additional measure
to reduce pain.
Well, they come in two flavors, shots and pills.
The pills are nonsteroidal anti-inflammatory drugs
while the shots consist of cortisone.
Both types of medications reduce the inflammation
but do not take the place of physical therapy.
Let's meet with one of our therapist
to talk about why therapy is so important
and what exercises you can do
to help regain your range of motion.
- The goals for physical therapy for impingement
the primary goal would be to identify
whether the impingement is a structural cause
or a functional cause.
So during our evaluation, we assess that
and then we determine where the patient is
in terms of the impingement process.
Primary goals for physical therapy
to decrease shoulder pain
are first of all, decrease inflammation.
The second goal of physical therapy
is to maintain the ability to move the shoulder
not lose motion, that's really key.
And then if the patient has too much motion,
to try to get them to control that motion through exercises
and that takes us to our last phase
which is the strengthening phase
or the specific phase of getting the patient
back to work or activity
and doing that through a broad exercise program.
The physical therapy for the shoulder again,
the pain limitation phase starts
with just some simple exercises
what we call pendulum exercises
or passive range of motion exercises
what we call table slides.
That allows the joint to heal
but not to lose it's mobility.
The first exercise that we're gonna instruct is pendulums.
It's a passive exercise to increase
the shoulder's range of motion
without irritating or causing pain.
So, you're going to do clockwise
and counterclockwise motions with a light weight.
Go back and forth and we're gonna do 20 of those.
- Okay.
Forward back.
- Perfect, nice and easy
and I always tell patients
pretend that weighs about 100 pounds,
so it just pulls on the arm.
You're relaxed through the shoulders, minimal arc,
and what this is doing is providing
a distraction on the shoulder,
maintaining motion, increasing circulations.
So it's a fantastic exercise for pain
and to maintain the range of motion.
Rotation exercises particularly internal rotation,
we do what's called a horizontal
or pulling the arm across your chest.
We also do a side-lying rotation exercise
to help the patients be able to reach behind their back.
And then, we actually have them reach behind their back
to mimic what they actually have to do
to get a jacket on for instance,
or to put their seat belt on.
And then lastly, the home exercise program
focuses on function, focuses on the ability
to have the strength and the endurance
to do all the exercises and to do them
without hurting themselves.
We always like to tell people
that we only see them on the average
three hours a week
and they need to follow-through.
The muscles and the joints have to get used to activity.
Pain is a limiting factor.
They have to do the icing.
They have to do the resting.
And then consequently, once that stage
of the rehab is concluded,
then we need to retrain the muscles
to do what they need to do.
So typically, you know, we like to see
patients getting better within three or four weeks.
And then after that, then they can do it at home.
The home exercise program really focuses on
the main reason why people come to therapy.
I think it's easy to treat the symptoms
and, you know, to take meds or to do ice.
But if you don't treat the cause
of what's creating those symptoms
and we typically see those patients back again.
So, we explain to them, we educate them
which is a big part of physical therapy
in conjunction with the home exercise program.
They need to do these exercises
so they don't see us again,
so they can be active,
so that they can work
and then not have to have a recurrence
of the shoulder symptoms.
- Let's talk about the role of arthroscopic surgery
in treating impingement.
Remember that an impingement,
we had a normal shoulder blade,
ball and socket is normal,
arm is normal but we had these bone spurs up above,
and we had that rotator cuff that had
some partial tears and inflammation.
And the bursa sac that was also inflamed.
With arthroscopic surgery,
step one is to remove those bone spurs.
This is A, this is C.
This is your ball and socket.
Trim the rotator cuff tendon
so it's nice and smooth.
And trim the bursa sac so it's back
to a more normal size.
Again, impingement of the shoulder
and the shoulder after arthroscopic surgery.
- Sometimes your symptoms can't be relieved
with just physical therapy and anti-inflammatories.
If non-surgical treatment doesn't help
then an arthroscopic procedure
for your shoulder is considered.
Two of the most common surgical procedures
are subacromial decompression
and a distal clavicle excision.
The main goal of both surgeries
is to get rid of any bone spurs
and to increase the space between
the acromion and the humerus
so your rotator cuff tendons
have room to glide without pinching.
After an arthroscopic procedure,
participating in physical therapy is important
because it helps you regain pain-free
range of motion and full strength of your shoulder.
The therapy following a shoulder arthroscopy
is very similar to a therapy you do
if you are treating rotator cuff impingement non-surgically.
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- Here's some tips on preventing
rotator cuff impingement syndrome from recurring.
First of all, continue to perform the exercises
given to you by your therapist.
Limit your repetitive overhead motion whenever possible.
Stretch your shoulder prior to any sports
or physical activity.
At Coordinated Health, we work as a team
in your treatment and recovery.
But remember, that you are the most
important member of that team.
You hold the keys to the success
of your own treatment.
Your consistent effort during and after treatment
build the foundation for maintaining
a pain-free shoulder.
Take what you learn from us,
continue to apply it in your daily life.
Spend a few minutes a day
to stretch and strengthen your shoulder.
This has a tremendous impact
preventing pain and loss of function.
And that's the Art of Medicine.
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