Massage shoulder impingement
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Impingement syndrome is when the rotator cuff tendons (supraspinatus, infraspinatus, teres minor and subscapularis) become trapped between the top of the humerus (upper arm bone) and the acromion of the shoulder blade.
Repeated impingement can lead to degeneration and thickening, which in turn will result in more impingement and trapping of the inflamed tendons.
The cause can be overuse, a single traumatic incident such as a fall, or arthritis. This is a common condition in swimmers, throwers, racket sport players, and patients with various types of arthritis. It also affects people who work for extended periods of time with their arms above the shoulders (e.g., drywall hangers, auto mechanics).
Pain in the shoulder when the arm is lifted above 90 degrees either forwards or to the side.
If the condition becomes chronic there will often be pain at night.
The following types of treatment are helpful:
Resting the painful tendon helps relieve soreness, allowing the shoulder time to heal. Avoid all movements and activities that increase pain. Take frequent breaks and limit any heavy lifting, overhead activities, or repetitive motion (like waxing a car or washing a window).
A shoulder sling may be worn for a short period. Gentle exercises should also be done. These movement exercises will keep the shoulder from tightening up and becoming a frozen shoulder.
The "rest position" of the shoulder is when the shoulder is supported "a little out, up, and in". In this position, the shoulder is in the least stressful position, relieving pressure and pain. This position can sooth the shoulder by relieving pressure.
Ice causes vasoconstriction. This helps control inflammation by reducing blood flow. Cold packs or ice bags are generally put on the sore area for 10 to 15 minutes. Ice massage is done by rubbing an ice cube or ice cup on a sore spot or tender point.
Physical therapists and chiropractors are trained in many different forms of massage and mobilization when treating the shoulder. Massage has been shown to reduce pain and spasm by helping muscles relax and by increasing blood flow. Soft tissue treatments can help tight muscles relax.
Deep transverse friction massage, is done by rubbing across the sore areas, especially muscles and tendons.
Electrical stimulation can ease pain and help remove any swelling. It is often used in combination with ice in the early stages and heat in the later stages of recovery. Once the pain eases, muscles that are in spasm begin to relax.
Ultrasound causes friction and warmth as the sound passes through tissue. Ultrasound helps provide heat to the deeper tissues of the body. This heating effect helps bring in a new supply of nutrient and oxygen-rich blood.
Iontophoresis uses a small machine that produces a mild electrical charge, which is used to transport medicine, usually a steroid, through the skin. The steroid is an anti-inflammatory medication that reduces inflammation.
Improving shoulder movement can help keep the joint surfaces aligned, while helping to control soreness in the tendons or bursa.
Careful stretching is important during the healing process. Stretching lengthens the sore muscles and tendons easing soreness and helping the shoulder back to normal health.
Strengthening can be started later in the course of treatment.
Injections of glucocorticoid may be helpful.
However, a newer treatment for tendonitis may be more effective than even surgery. Percutaneous needle tenotomy is a technique where a small gauge needle is introduced using local anesthetic and ultrasound guidance. The needle is used to poke several small holes in the tendon. This procedure is called "tenotomy." Tenotomy induces an acute inflammatory response. Then, platelet rich plasma, obtained from a sample of the patient's whole blood is injected into the area where tenotomy has been performed. Platelets are cells that contain multiple healing and growth factors. The result? Normal good quality tendon tissue is stimulated to grow with natural healing. For more information:
Tendonitis TendonitisandPRP.com provides reliable, accurate, and useful information on tendonitis treatment written by a board-certified rheumatologist. Learn more about how to get tendonitis relief using the most up-to-date methods.
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