Abstract

Shoulder Impingement: Biomechanical Considerations in Rehabilitation

Paula M. Ludewig, The University of Minnesota, USA

There is a growing body of literature relating abnormal shoulder movement patterns with the presence of shoulder pain and dysfunction. During elevation of the am overhead, the scapula should upwardly rotate, posteriorly tilt, and internally or externally rotate to follow the thorax. In persons with impingement, alterations of reduced scapular posterior tilting and upward rotation, as well as increased scapular internal rotation have been identified.  Several advances in the understanding of 3-dimensional shoulder complex function and dysfunction have occurred in recent scientific investigations. Thus abnormal mechanics may be contributing to the development or progression of subacromial impingement beneath the coracoacromial arch or internal shoulder impingement against the glenoid or glenoid labrum. This presentation will update current knowledge on normal and abnormal shoulder complex motion, including clavicular motion patterns. Altered muscle function identified in shoulder impingement has included excess upper trapezius activation and reduced serratus anterior activation. An overview of potential mechanisms contributing to abnormal movement patterns including soft tissue tightness, altered muscle activation, and thoracic posture will be provided. Scientifically based implications for shoulder evaluation and rehabilitation interventions will be presented, including sub-grouping of movement deviation types. Evidence for effectiveness of targeted exercise programs in cases of shoulder impingement will be reviewed.  In particular, there is scientific support for the use of serratus anterior strengthening, pectoralis minor and posterior shoulder stretching, and thoracic extension exercises as adjuncts to traditional glenohumeral exercises for shoulder impingement.

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