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Shoulder Subacromial Impingement

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M1ST
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2011/04/10 13:57:25 (permalink)
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Shoulder Subacromial Impingement

Hi All,
 
Following an X-ray and an MRI scan my doctor has diagnosed me with having subacromial impingement in my shoulder and recommended surgery to shave away a part of the bone which has caused the narrowing.  This would be followed by about 12 weeks of physio. Overhead movements, incline movements are just agony, and my everyday life has had a drastic impact.
 
I haven't trained upper body now for around 5 weeks allowing any inflamation to heal but I am a little reluctant to go down the surgery route without first considering any non-surgical methods.
 
There has been much talk about ART (Active Release Techniques) which can apparently cure this syndrome. I wanted to ask any experienced folk out there if they have either this technique for impingment or if there are any other alternatives worth considering?
 
Many Thanks!
#1

26 Replies Related Threads

    Ak_88
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    Re:Shoulder Subacromial Impingement 2011/04/10 14:03:13 (permalink)
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    Have you had any conservative (i.e physio) treatment for this problem? Can't comment too much on ART, but essentially what you have is a decreased space between your head of humerus (arm bone) and acromion (shoulder bone), which causes irritation to the tendons and bursae (sacs of fluid) that run between this small gap.
     
    I'm not sure on the success of the surgery you describe, I would be looking at it as a last resort. If you haven't had any conservative treatment, it may be worth considering cortisone to clear the inflammation and allow you to go down the physio route to help any mechanical issues you have.
    #2
    M1ST
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    Re:Shoulder Subacromial Impingement 2011/04/10 14:12:58 (permalink)
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    Thanks AK_88, Over the last few weeks I've been seeing the doctor to have this diagnosed and as of only yesterday was my first session seeing an Osteopath. I did request the Doc to see if Cortisone would help but he specifically said it won't do much in this case apart from supressing pain for possibly a week or two.
     
    TBH, I would rather avoid surgey as I've had surgery on my knees and appreciated it's different to a shoulder but my knees have never felt the same again. I think I will exhaust all physio routes before going down the route of surgery.
    #3
    Ak_88
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    Re:Shoulder Subacromial Impingement 2011/04/10 14:27:02 (permalink)
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    I would see what your Osteo says about cortisone, no disrespect to GP's but they don't have as much experience as rehabilitation therapists when it comes to determining how effective these things are. He may be very switched on, so as you can imagine it's difficult to say for sure over the internet.
     
    Some people get months of relief with cortisone, others only a few weeks unfortunately. Find out from your Osteo what he thinks about the situation, no worse a situation than doing something without actually understanding why it's being done IMO!
     
     
    #4
    TheThumper
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    Re:Shoulder Subacromial Impingement 2011/04/10 14:29:39 (permalink)
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    I had some shoulder issues when I was throwing the javelin. ART can really help and I would look at this before looking at a shot. I believe it is the supraspinatus that can get caught on the acromion and you can release this by targeting trigger points around the traps and upper back.
     
    It may also be a postural issue with your shoulders rounding forward and compressing on the joint.
     
    It might also be a structural issue, in which case surgery may be a realistic option because the acromion might simply be hooking the tendon.
    #5
    fun meter
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    Re:Shoulder Subacromial Impingement 2011/04/10 18:23:23 (permalink)
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    99 times out of a hundred, its down to posture and biomechanics. Because impingement occurs every day, even if you dont have any pain.
     
    But if your older and adaption has occurred, or unfortunately have acromion with a hook shape then surgery is more likely. Like anything, could go fine, or like a friend of mine the surgery stopped the pain and impingement, but the shoulder still aches.
     
    Either way, surgery or not, working on your whole bodies posture is vital for a more positive outcome.
    http://ericcressey.com/
    I cant recommend enough visiting Eric Cressey's site and just reading his articles. Will help explain a lot, and put you in the right direction with some ideas of things to do to help. If theres something he doesnt know about shoulders, it isnt worth knowing.
     
    Took time, but I have / had torn supraspinatus, bicep impingement and inflamed bursa on my right side. Through learning and working to improve biomechanics i over came the injury. Although a sh*t injury, if it didnt happen I would know what I do now.
    #6
    M1ST
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    Re:Shoulder Subacromial Impingement 2011/04/10 19:31:29 (permalink)
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    Thanks for all the very helpful replies guys :)
     
    An extract from my MRI report:
    "The lateral acromion slopes inferiorly in the coronal plane and there is some narrowing of the acromiohumeral distance at this site."
    "Conclusion:
    1. Bone marrow oedema in keeping with a possible stress response in the superior glenoid and base of the coracoid process.
    2. Narrowing of the acromiohumeral distance at the lateral acromion.
    3. No abnormality of the rotator cuff muscles and tendons.
    4. No labral tear has been demonstrated.
    5. No abnormality at the acromioclavicular joint.
    6. No abnormality of the long head of the biceps tendon."
     
    I'm quite sure I don't have a hook shaped acromion and it is pretty straight from what I can remember of the x-rays.
     
    #7
    Ak_88
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    Re:Shoulder Subacromial Impingement 2011/04/10 19:53:19 (permalink)
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    Far from an expert opinion, but in english it sounds like your affected scapula is protracted and/or rotated forward, which causes the humerus to sit in a mechanically poor position, leading to the decreased space between bones and hence the oedema.
     
    In short - work on your posture IMO. Does your Osteo have a copy, and has your GP or anyone gone through those findings with you?
    #8
    Rachfit
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    Re:Shoulder Subacromial Impingement 2011/04/10 21:15:42 (permalink)
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    HI Mist
    I agree that if possible you should try and avoid anything intrusive at least until you find the cause.
    It is very common that we discuss the problem and symptoms and yet the most important information has to be what has caused the injury in the first place.
    This missing link in the medical and exercise professions is very often the reason we continue to suffer even after treatments or sugery because if we do not correct the actual cause the symptoms will always return.
    So you did not mention in your OP about what caused your impingement?
    I strongly recommend you find a fully qualified biomechanics coach who can assess your mechanical function and objectively measure potential causes of this problem.
    The simple exercises they are also skillled in prescribing to correct dysfunction, will release excessive load off the site of the problem therefore reducing symptoms, potentially in some cases having immediate relief.
    Good luck!
     

    "If you cant explain it simply, you dont understand it well enough" Albert Einstein
    Rach
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    Specialist Biomechanics Coach 
     
    #9
    M1ST
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    Re:Shoulder Subacromial Impingement 2011/04/11 14:54:48 (permalink)
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    Many Thanks for the replies, I was given a very vague description of the cause which was 'weight lifting' from the shoulder specialist I saw. I'm bypassing the GP and went private, as initially the GP diagnosed this as tissue damage hense the loss of faith there.
     
    I did see a Chiropractor, along with my MRI report, who mentioned that my posture wasn't actually that bad for someone who sits in front of computers all day and does bodybuilding as a hobby. I'm seeing an ART specialist in paralell next week to try and identify the cause and remediate the current issue. I'm already looking at alternative techniques for excercises which are known for making the impingement worse.
     
    I've had better advice here than I have had from Doctors and 'Specialists'. Thank you again! :) 
    #10
    Rachfit
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    Re:Shoulder Subacromial Impingement 2011/04/11 15:13:05 (permalink)
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    Weight lifting is not a 'cause' but an affect. I lift weights but do not have this problem so mechanically something is different in side you than others and that is what you need to find out.
    When you get checked by a professional make sure that they check your leg length, pelvic alignment and function, nerve tension and for sub clinical muscle spasm in each individual joint  in the body otherwise they will not have a complete picture of the chain of events that could have caused your inpingement.
    If any part is misssing then that potetnially could be the cause, or at least part of it, so if not addressed the problem is going to come back. Do ask for a full bodyMOT and if they dont assess all of the above then let me know

    "If you cant explain it simply, you dont understand it well enough" Albert Einstein
    Rach
    DipITS MBCA
    Specialist Biomechanics Coach 
     
    #11
    M1ST
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    Re:Shoulder Subacromial Impingement 2011/04/13 10:34:57 (permalink)
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    Thanks Rachel, I'm booked up to see the people over the weekend and will keep you guys posted :)
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    rockstar6181
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    Re:Shoulder Subacromial Impingement 2011/04/17 21:17:59 (permalink)
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    how did you get on?
    #13
    M1ST
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    Re:Shoulder Subacromial Impingement 2011/04/17 23:03:31 (permalink)
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    Hi All,
     
    I've managed to get in two sessions, and already the pain has signifcantly reduced, although the impingment is still there and I can feel this when I raise my arm. We went through my excercises that I would do in the gym and the one that stuck out was, 'behind the neck shoulder press'.
     
    Also, my shoulders slant forwards most likely caused by my day job, which requires sitting in front of a computer which hasn't helped my posture either.
     
    We are pretty sure that there is also some tendonitis which didn't show up on the MRI scan from the tests that were conducted. Although I have been warned if the impingement is significant surgery may still be the route to go, but for now we'll keep trying since progress has been made.
     
    However it's been well worth it so far and learning about how I may have caused it, excercises to avoid and alternative excercises.
     
    Tomorrow I'm seeing an Active release technique specialist. Will also post how that goes!
     
    (In good spirits) Thanks!
    post edited by M1ST - 2011/04/17 23:04:47
    #14
    Ak_88
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    Re:Shoulder Subacromial Impingement 2011/04/18 08:46:41 (permalink)
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    Good to hear you're on the right track - as you say BTN press can be a stinker for some as you force the shoulder joint into a lot of horizontal abduction and external rotation by going behind your head.
     
    What's the plan for now then, exercise and 'hands on' therapy it sounds like?
     
     
    #15
    M1ST
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    Re:Shoulder Subacromial Impingement 2011/04/18 18:18:51 (permalink)
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    Absolutely, AK88, plenty of therapy and avoiding exercises that add pressure in that joint.
     
    I saw a ART specialist Chiropractor today, I went in with a very sceptical attitude but it was a very humbling experience. As I walked in I saw pictures of various sports athletes including some Olympic athletes with their testimonials.  At which point I thought, hmm. 
     
    Anyway, as he asked a few questions about the injury, he went on to do the examination, and just by pressing on various points, he managed to identify a history of injuries I have had, including bicep tendinosus in the same arm (last year, which I thought was cured) and migraines (which I still get). I was quite amazed at his findings as I didn't mention any of this to him. He seems to think the bicep tendinosus is linked and he can help for sure.
    I know too many cooks can spoil the broth but there can't be any harm in seeing an Osteopath and a Chiropractor?
     
     
     
    #16
    Ak_88
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    Re:Shoulder Subacromial Impingement 2011/04/18 18:23:54 (permalink)
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    I wouldn't bother mate, stick with one or the other; chances are you'll get conflicting advice and opinions and just end up confused. Stick with one and follow their advice. 
     
    If you're seeing two chiropractors which it sounds like? then either get them to communicate with each other or relay your information to each of them for the same reasons above, no point pissing into the wind.
    #17
    M1ST
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    Re:Shoulder Subacromial Impingement 2011/04/21 14:22:19 (permalink)
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    Another session with an ART Chiropractor, and I can honestly say it's already making a huge difference.
     
    He has confirmed that certain excercises triggered this as a result of the bicep tendinosus, but the good news is that surgery is out the window now and I'm well on track to recovery. We are working on getting rid of the scar tissue, and there is a significant amount of it. Following this will be some Rehab work, and estimated time for full recovery is around 3 months :)
     
     
    #18
    TheThumper
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    Re:Shoulder Subacromial Impingement 2011/04/21 20:39:57 (permalink)
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    Good sun.
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    rockstar6181
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    Re:Shoulder Subacromial Impingement 2011/04/24 14:34:51 (permalink)
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    out of interest what type of exercises, stuff does a ART expert do? I have a horrible nagging shoulder problem - feels like a knife stabbing into the nerve at times (when i move my arms outwards) if I rotate my arm around there is a clunk, click and then something frees up and feels okish.
    Is this in line with your symptoms?
    #20
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