Rotator cuff syndrome/tear Vs. impingement syndrome
Many people over the course of their lifetime will be affected by shoulder pain. Shoulder pain can be related to numerous activities and can affect the active and non-active patient. An example of an athletic injury would be when a patient is working out in the gym doing an overhead kettle bell swing. After performing the kettle bell swings they start to have intense shoulder pain. Another patient who is not as active but had a recent fall onto their outstretched arm will then have pain/weakness with all activities including simple things such as dressing. Let’s take a closer look at each individual patient and break down the differences between the two injuries and how each potential rehab would play out.
Patient one (the athlete presents with shoulder impingement syndrome)
This patient is in generally good condition when they present at their examination with the Physical therapist. The Physical Therapist should take the patient through a full exam for the impaired shoulder. This would involve a range of motion and strength test. It is hard to say whether or not they will have a full range of motion and strength. Every patient is different. However, it is safe to say that these patients will have good strength measurements and fairly full range of motion. The patient usually has pain at the end shoulder flexion range of motion, which is raising your arms overhead as if you were raising your hand in school (That being a self-test you can perform).
What has happened in the case of shoulder impingement is that this patient has done a repetitive activity which at the time was not done with correct form and resulted in pinching the rotator cuff muscles under the AC joint. Again there can be all types of different issues that can be an underlying cause of shoulder impingement but for our purposes, this repetitive trauma caused this patient’s injury. These injuries generally do well with conservative treatment of about 4-6 weeks depending on how severe the impingement is. Please see the picture below of what the shoulder joint looks like when the impingement occurs. The best way to resolve this problem is to see a Physical Therapist so he or she can guide you with a proper exercise program in combination with manual therapy stretches, modalities such as electrical stimulation, ultrasound and heat treatments to ensure proper/speedy recovery.
Patient two (the non-athlete who fell presenting with rotator cuff syndrome/tear)
These patient’s coming into my office are usually in quite a bit of pain. Usually exhibiting a limited range of motion in the shoulder and weakness when asked to resist on the strength testing. Your therapist should take you through a full examination and based on those findings, determine the best course of action. Things like your pain level, a range of motion, and strength findings all help the therapist decide if physical therapy will be effective.
If the patient is having a lot of weakness and a high level of pain associated with decreased range of motion, a visit to an orthopedic MD to rule out a high-grade tear with an MRI is warranted. Those high-level tears can require surgery. If the tear in the rotator cuff is small it can be handled in the Physical Therapy clinic. Hands on manual therapy techniques can be very effective. In addition, electrical stimulation/heat and ultrasound treatments also can be beneficial. The therapist will also provide you with the appropriate exercises and progressions to help those injured muscles heal correctly.
by Frank Ruggiero DPT