Non Operative Treatment
Subacromial injection of local anaethetic and cortisone or actual needling/aspiration of the calcium under ultrasound guidance. Needling is done in the rooms under local anaesthetic; this is successful in about 2/3rds of patients but the paradox is that even when no calcium is sucked out, there can be complete resolution and vice versa. i.e. when a large amount of calcium comes out there may not be complete resolution.
Physio is aimed at stretching exercises to loosen up the capsule or lining of the joint. Strengthening of the rotator cuff muscles and the muscles that stabilse and move the scapula ( shoulder blade).
Tightness of the back of this capsule is implicated in the causation of impingement. Tightness of the posterior capsule leads to the ball or humeral head being pushed forward which results in impingement when the arm is elevated. Stretching of the back of the capsule is important in helping resolve it.
This is done in the following ways:
Standing or sitting.
Take the hand of you affected arm across your body towards the opposite shoulder.
Give gentle assistance with your other arm.
Repeat 10 to 30 times and do 2 to 3 times a day.
Strengthening of the Rotator Cuff Muscles
The function of the rotator cuff muscles is to stabilise and mobilise the shoulder. They keep the ball (humeral head) in the socket. If there is any weakness of the rotator cuff muscles then the humeral head may move slightly abnormally resulting in rotator cuff impingement. Strengthening of the rotator cuff muscles will help prevent or resolve impingement.
This is done by strengthening the muscles that turn the arm outwards (external rotation) and the muscles that turn the arm inwards (internal rotation)
STRENGTHENING OF EXTERNAL ROTATION
Shown for the left arm
Sitting or standing with your elbow bent.
Keep your elbow INTO your side.
Hold one end of elastic band – other end fixed.
Start with your hand in front of your stomach and pull hand outwards until it is in front of you.
CONTROL the movement on return and do NOT try and pull out too far.
Repeat 30 times
STRENGTHENING OF INTERNAL ROTATION
Shown for the right arm
Stand with arm close to your body and elbow bent.
Hold rubber elastic band – other end of band fixed.
Pull your hand towards your stomach.
Keep the elbow in.
Control the movement on return.
Repeat 30 times.
Strengthening of internal and external rotation can be done with dumbbells in the following way:
STRENGTHENING WITH DUMBBELL – External Rotation
STRENGTHENING WITH DUMBBELL – Internal Rotation
Repeat 30 times
Strengthening of the Scapular muscles
Stengthening of the scapular muscles which control the position and movement of the shoulder blade is important.
With your feet 3 feet apart and keeping the elbows straight, adjust the rope so the weight is just resting on the ground.
Now shrug your shoulders so the weight is lifted off the ground.
With your feet 2 feet apart and hands on the wall in front, bend your elbows till your face almost touches the wall.
Start with doing 10 repetitions and then moving to do 30 repetitions.
You should do all these exercises 2 to 3 times per day.