Shoulder Impingement

My ability to feel problems in tendons due to my blindness, and skill as a shockwave therapy professional gives me the ability to resolve most occurrences of supraspinatus impingement. I can accurately direct the shockwaves so they don’t miss the various points of dysfunction along the full length of the tendon making treatments efficient and effective. It usually requires 3-6 treatments to achieve the goals necessary to solve this condition.

Shoulder impingement is a condition characterized by several dysfunctions within the supraspinatus tendon, one of the 4 main rotator cuff tendons of the shoulder. Impingement implies that the tendon has more than just tendonitis within its fibres, but rather a more serious potentially devastating one.

Supraspinatus tendonitis most often occurs at its point of attachment (insertion) on the front of the shoulder (humerus bone). If the tendon is exposed to the same repetitive damaging forces responsible for the tendonitis to occur, further damage will result back on the tendon where it must pass underneath the acromion (bony plate of the shoulder). There is no room under the acromion for a swollen tendon to pass freely during shoulder movements. Impingement means the supraspinatus tendon is swollen, has one or more regions of disorganized fibres resembling lumps which don’t allow it to glide smoothly under the acromion. Impingement means the tendon gets stuck or impinged.
Bursitis typically results due to this friction beneath the acromion, because the region is full of bursas and are assuredly irritated whenever the shoulder is moved.
The severe pain associated with most cases of shoulder impingement comes from the swelling of the supraspinatus tendon, the swollen bursa (bursitis), and from the irritation of free nerve endings all through the shoulder form a general state of swelling.

Treatments bring rapid relief by flushing out the swelling in the region, swelling from the bursa, and tendon. Subsequent treatments are intended to break apart the disorganized tendon fibres, break apart any calcifications common to the condition, and to soften the entire tendon allowing it to heal. Most cases of shoulder impingement are curable unless the tendon has suffered a severe tear or total rupture which would require surgery. Minor tears are treatable and would not require surgical intervention to resolve.

Description: What Is Shoulder Impingement?
Impingement of the shoulder is the medical term used to indicate a problem with the tendon (tendinopathy) within a specific rotator cuff muscle called the supraspinatus.
The supraspinatus tendon attaches to the supraspinatus muscle on the upper portion of the shoulder blade. The tendon travels under the flat bony plate (acromion) of the shoulder and comes out on the front of the humerus where it is attached.

Impingement means that the swollen injured tendon is severely restricted (impinged) as it must glide underneath the acromion of the shoulder whenever the arm is in motion.
The term “Rotator Cuff” is not a physical structure of the shoulder. Rather it is a term which identifies 4 main stabilizing muscles and their tendons of the shoulder. The supraspinatus muscle is one of the four. The other three are the infraspinatus, subscapularis, and the teres minor muscles.
Every muscle in the body is attached to a bone by a tendon, so this text will refer to the supraspinatus’s tendon.

Symptoms:
The most common symptom of shoulder impingement is pain on the front of the shoulder because this is where the supraspinatus tendon attaches.

Symptoms of impingement include:

  • Pain and/or weakness, when raising the arm forward or to the side
  • Pain and/or weakness when trying to raise the arm above the head
  • A Vague ache into the shoulder, down the back of the arm, into the elbow, wrist, or fingers
  • Pain while lying on the back
  • General stiffness in the shoulder
  • Sharp pains when using the shoulder
  • Clunking feeling deep within the shoulder
  • Numbness and/or pins/needles sensations into the shoulder, down the arm, or into the hands. 

Causes:
Shoulder impingement results from repeated strain over many months or years on the fibres of the supraspinatus tendon.   The supraspinatus muscle and its tendon is the most used muscle of the four rotator cuff muscles, so is the most often one injured. The tendon is long and thin, working extremely hard with all shoulder movements, making it susceptible to injury.  The hundreds of thousands of fibres which comprise the tendon run lengthwise and are firmly attached to each other, providing a steel cable-like structure.

Tendon Disorganization
Repetitive strain on these fibres can lead to their becoming disorganized, meaning they become twisted and entangled back upon themselves. This occurs in sections of the tendon’s fibres where the most strain occurs. This is usually on the front facing aspect of the tendon.

Tendonitis/Tendonosis
Tendonitis is the fraying of individual fibres much like an old yellow nylon rope exposed to the weather. These frayed fibres begin to separate from the other fibres longitudinally and may break apart.   Pain and swelling develops in this region of the tendon, causing weakness in the muscle.

Tendinosis means that the fraying has stopped causing painful inflammation and for the time is not causing any issues with the muscle. The tendon is still injured but you would not know it due to the lack of symptoms at this time.

Tendonitis and tendinosis will typically cycle between each, going from pain and swelling and weakness, to nothing at all, and back to pain, swelling and weakness.  These are the 4 main issues which cause impingement of the supraspinatus tendon of the shoulder.

In all 4 situations, the tendon becomes swollen due to the inflammation being created. Tendons are like sponges capable of absorbing and holding an enormous amount of inflammatory fluid, doubling the diameter of the tendon.  Scar tissue may develop within the affected regions of the tendon. Both cause the tendon to become thicker and less capable of gliding underneath the shoulder (acromion) resulting in restriction (impingement), thus pain, tightness, and weakness.

Shoulder Impingement Treatment
We use our most powerful professional shockwave unit, the exact one used in our non-surgical bunion removal process, to resolve shoulder impingement. We also use magnetic therapy when necessary to help speed up the process and reduce pain.

Treatment provides the following:

  • Quickly eliminates pain in the shoulder, so that daily activity and sleeping at night return to normal
  • Remove unwanted metabolic waste products, painful inflammation, and chemical messengers from the injured tendon. This reduces the production of inflammation, thus reducing pain and immobility
  • Initiate the repair process to the injured region of the tendon. Very strong collagen connective tissue fibres invade the injured region, repairing the disorganized fibres 

A total of 3 or 4 treatments typically resolves most occurrences of shoulder impingement.  Treatments take between 45-75 minutes to complete, depending on the severity of the condition, and if other tendons or muscles are involved.

For more information on our treatment for shoulder impingement, please contact us, or arrange for a no-charge consultation/assessment.

     

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