SHOULDER TENDONITIS
The most typical complaint in the pathological shoulder is a painful arc, or pain in elevating the arm (also known as Subacromial Impingement Syndrome) through an arc of 80- 120 degrees.
This pain is due to the impingement of rotator cuff tendons under the acromial arch due to the proximity of the tendons and acromion in this arc of movement.
Two theories contributing to impingement syndrome have emerged.
Intrinsic theory: suggests that an intrinsic tension overload on the muscle and tendon rather than external impingement is the major factor in the cause of rotator cuff tendonitis.
This phenomenon is often most dramatic in persons who participate in overhead sports and in manual laborers who use overhead motions in their work. The inflammation caused by repetitive movements causes a swelling of the tendons and leads to friction and wear against the coracoacromial arch.
This theory proposes that the inflammation associated with tendon degeneration and the resulting weakness in the cuff allows a proximal migration of the humeral head, thus perpetuating the impingement and could lead to complete tears of the rotator cuff.
Early cuff rehabilitation and scapular stability drills are essential in preventing progression.
Extrinsic theory: suggests that the primary cause of degeneration in the cuff is due to the mechanical compression of the cuff tendons in the subacromial space.
Factors contributing to this theory include the shape of the acromion, disturbed scapulohumeral rhythm, degeneration of the acromioclavicular joint, and glenohumeral instability leading to altered mechanics in elevation and impingement.Restoring normal scapulohumeral rhythm and the provision of a progressive rotator cuff strengthening program are the essential components to the successful rehabilitation of any impingement syndrome.
The ability for the patient to tolerate a progressive cuff program moving towards functional positions and activities can be enhanced by manual therapy regime focusing on posterior capsule flexibility, reducing the tonicity of accessory muscles such as levator scapulae and latissimus dorsi, improving unilateral thoracic extensibility and optimizing scapulohumeral rhythm through the reeducation of scapular muscles such as lower trapezius and serratus anterior.
