Appropriate stretching exercises of the shoulder joint prior to partaking in sports or gym. This is aimed particularly at stretching of the posterior capsule or lining of the joint.
Initially rest, avoidance of movements that cause pain, anti-inflammatories and physiotherapy are prescribed.
It is best to consult a physiotherapist initially to explain and assist you with the exercises.
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 the 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 way:
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 left arm)
Sitting or standing with your elbow bent. Keep your elbow IN 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. Repeat 30 times
STRENGTHENING OF INTERNAL ROTATION (shown for left arm)
With your forearm elbow bent and held against your side; you forearm and hand straight out in of your body. 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 also be done with dumbbells in the following way:
STRENGTHENING OF EXTERNAL ROTATION
Repeat 30 times
STRENGTHENING OF INTERNAL ROTATION
Repeat 30 times
STRENGTHENING OF SCAPULAR MUSCLES
The scapula function is often altered in impingement with resultant winging of the scapula and altered scapulothoracic rhythm. Strengthening of the muscles that control scapula movement is important and can be done as follows:
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.
If this treatment is unsuccessful, then local anaesthetic and cortisone injections may be given.
A maximum of 3 of these injections in one course (i.e.: 3 to 4 weeks apart).
These conservative measures will resolve the condition in up to 50% of cases.