Sub-Acromial Pain Syndrome (Shoulder Impingement)

Shoulder Pain with Muscle Power Deficits

Screen Shot 2018-10-24 at 7.43.12 PM.png
  • Sub-acromial pain syndrome is perhaps the most common cause of shoulder pain in patients and a frequent cause of primary care physician visits. Patients will often present with sharp shoulder pain exacerbated in mid ranges of shoulder movement and repetitive activities. Take a look at some ways to assess and treat this common pathology!

  • If you do not know the common clinical findings no problem! Click here


Anatomy

Picture1.png

Image via Complete Anatomy 2018 by 3D4 Medical


Movement Faults

Postural and movement faults tend to be common in individuals with sub-acromial pain syndrome with downward rotation, depression, abduction, anterior tilt, and winging being common scapular faults, and internal rotation along with anterior glide being common humeral faults. Excessive thoracic spine kyphosis can also contribute! Take a look at how scapular downward rotation is assessed and corrected! (Click image to watch 1-2 minute video)

Key Finding

The Hawkin’s Kennedy Test alone has a decent positive likelihood ratio (+LR) of 2.11 for incidence of sub-acromial pain syndrome; however, when clustered with a painful arc of movement and weak/painful external rotation resistance test the +LR increases to an excellent 10.56! (Click image to watch 1-2 minute video)

Treatment/Therapeutic Exercise

If the patient presents with scapular downward rotation or depression during shoulder elevation, it is likely that the serratus anterior and/or lower trapezius are not activating properly. Wall slides are an excellent exercise to reinforce activation of these muscles and improve potential movement faults! (Click image to watch 1-2 minute video)

*Clinical Side Note: As always, assess the patient as a whole. It is highly likely that other contributing factors are present! Tackle the impairment that is contributing the most and address the others as treatment progresses.