Treating Impingement Syndrome and Rotator Cuff Tendinitis

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1 Treating Impingement Syndrome and Rotator Cuff Tendinitis Dennis Gyllenhaal, PT, Adient-Gyllenhaal Physical Therapy If you have been diagnosed with impingement syndrome of the shoulder or rotator cuff tendinitis your treatment and progress will be influenced by several factors including: Your age Other medical conditions such as diabetes Your activity levels including sports, overhead reaching, reaching to the side and other repetitive activities which could irritate the structures that have been injured. Underlying factors Weakness of the rotator cuff and overpowering of the deltoid Swelling Painful arcs of movement Scapular (shoulder blade) muscle imbalance Functional movements (repetitive overhead or reaching movements) Goals Reduce swelling of the structures in the sub-acromial space Restore pain free motion Strengthen rotator cuff and scapular muscles Restore a normal ratio of movement between the arm and shoulder blade You physician may choose to give you a cortisone shot to help reduce the swelling in the tendons and sub-acromial space. Often (but not always) the relief is nearly instantaneous. Many individuals will take this as an indication that they can return to their prior level of activity with no further intervention. This could lead to the return to symptoms after the effects of the cortisone have worn off. In therapy, your therapist will evaluate the following: The range of shoulder motion compared to normal range and compared to your

2 unaffected arm. They will note painful arcs of movement and restrictions of movement The tightness (or laxity) of your joint capsule. Tightness in the joint capsule can produce abnormal patterns of motion that are associated with pain The strength of your rotator cuff muscles The movement of your shoulder blade relative to the upper arm. Your shoulder blade floats on your rib cage and must move in such a way that the socket maintains an adequate level of contact with the head of the humerus (the ball). Once your therapist has assessed these factors, he/she will develop a program to restore pain free motion, re-store rotator cuff strength, and restore normal rhythm between the shoulder blade and arm. That program could involve physical modalities such as ultrasound, ice and electrical stimulation. Manual therapy can help re-establish normal capsular mobility, and finally exercises can help establish normal range of motion and muscle balance. The exercises used for rotator cuff tendinitis and impingement syndrome specifically at the muscles of the rotator cuff verses the larger muscles such as the deltoid and lats. They also target the muscles that control the shoulder blade as the timing (or rhythm) between the shoulder blade and arm is essential to raising the arm above shoulder level safely and without pain. Some of the exercises that you may be given are listed below. Please do these under the guidance of your therapist. Pendulum Exercises

3 Stand behind a kitchen chair or by a low table with your unaffected arm supporting your upper trunk. Bend forward from the hips and left the affected shoulder dangle. Slowly swing your arm forward and backward in about a 1 foot arc. Keep the arc small and relaxed. Next swing your arm side to side in front of you again in a 1 foot arc. Finally swing your arm in small circles first clockwise, then counter-clockwise. Strap Distraction Place the loop of a dog leash around our wrist. Step on the other end of the leash so that there is tension on the leash and your arm is out straight. Slowly lean away form the leash which should apply pressure in a downward motion. Hold

4 with a comfortable level of pressure on the arm for 10 to 20 seconds, then relax. Active External Rotation Stand with both arms at your side and elbows bent 90º. Rotate your arms out as far as possible while pinching your shoulder blades together. Hold this position for 5 seconds. Scaption (Thumbs up) Stand holding a lb weight in your hand. With your elbow straight and your thumb

5 facing forward, turn your thumb out 45º and raise your arm up following your thumb. Scaption (Thumbs Down) Stand holding a lb weight in your hand. With your elbow straight and your palm facing backwards raise your arm forward and out at approximately a 45º angle from straight forward. Raise to approximately 4-6 inches below shoulder level. Theraband External Rotation Hold the theraband in your hand with your elbow at your side and bent 90 degrees. Rotate your arm outward as far as you can comfortably, then return slowly.

6 Theraband Scaption Hold the theraband with your palm facing backwards and your thumb facing the anchor. Slowly pull your arm out away from your body. Go no further than 18 inches from the body and return slowly. Theraband Tummy Pull Stand, facing the anchor with your arm pointing at the anchor and elbow straight. Pull your hand directly towards your stomach letting the elbow go out to the side. Release slowly. Sidelying External Rotation

7 Lie on your uninjured side with you injured arm tucked against your side, the elbow bent at 90º. Holding a lb weight, raise your hand up rotating the shoulder outward. Sidelying Flexion Lie on your side with your injured arm up. With the elbow straight, raise your top arm forward and over your head, keeping the arm parallel to the floor. Return your arm slowly to your side.