Impingement syndromes are syndromes
where the rotator cuff tendon
becomes inflamed, or the subacromial
bursa or other soft tissues
are trapped or impinged in
that suprahumeral joint.
So, right above the humerus, you have many different structures
that pass in that area including
the supraspinatus tendon.
So, if you have an inflammation
of the bursa there,
if you have irritation or
thickening of the capsule,
if you have that tendon thickened or
calcifications that occur at the humerus,
that could potentially compress with
certain motions of the shoulder.
Sometimes if you have a recent fall or trauma,
that could also irritate the region.
Special tests include the
Neer’s Test or Hawkins' Test.
Both of these tests induce internal
rotation and abduction or flexion
which compresses that
So, a positive test
would recreate pain.
Usually if someone has
an impingement syndrome,
medical management includes
taking anti-inflammatories, rest.
Ice could sometimes decrease
some of the inflammation.
Osteopathic treatment could be used to help
decrease some of the muscles in the area.
Certain treatments can help
and help with decreasing any sort of
edema that might be in the region,
and trying to remove restrictions to try to
improve range of motion of the shoulder.
So, one of the tests that we
could perform to check
for impingement syndrome
is the Neer’s Test.
The mnemonic to kind of
is that you're moving the shoulder
joint near to the ear.
So here, what we're going to do is going to
internally rotate the patient's arm
and then passively flex the arm
until the hand is above the head.
The suprahumeral space
when you internally rotate
and add flexion to the joint
will be compressed.
So, you're mimicking
the impingement there.
If there is impingement of the structures
or the rotator cuff muscle there,
the patient will have
pain with the test.
So, positive test is
complaints of pain
or really being unable to do
the test secondary to pain.
The Hawkins' test is a test for
impingement of the rotator cuff.
Here, we're going to start with flexion
of the elbow to 90 degrees
and then add internal
rotation of the shoulder.
When you add internal rotation
to an already flexed shoulder,
you're actually compressing the humerus
and closing that suprahumeral space.
So, a positive test is if a
patient complains of pain
or is unable to perform
that motion in the region.
Adhesive capsulitis is also
known as frozen shoulder.
This is an inflammatory process that
results from immobilization.
So, our shoulder joint has
a lot of freedom of motion.
Due to that freedom
there is a lot of excessive tissue
and fascia in the region.
If we immobilize the shoulder
for a prolonged period of time,
all that tissue becomes
It could start to kind of
So, it is important to try to mobilize
the shoulder when we can
especially after any sort of immobilization
like a patient being in a sling,
or being bedridden, or in a hospital bed for a
while and not really moving their joints.
Diabetic patients have an increased
risk of developing adhesive capsulitis.
If you do have it, it has a
real significant effect on
your activities of daily living and
really prevention is the key.
So, after any sort of immobilization,
we want to get the shoulder moving
and going through different exercises
or therapies as soon as we can.
One way to screen for this
is to have the patient perform
what's called the
Apley’s scratch test.
It is an active range
of motion test
where you're taking the shoulder do different motions and movements
to quickly screen
and compare sides
to see if the patient has a
decrease in range of motion.
Osteopathic manipulation could help
with freeing up some of that tissue,
getting the shoulder moving better
through the range of motion.
So, a special test that we could perform
to screen for range of motion
of the shoulder is the
Apley’s scratch test.
What this will screen for is
if the patient has any problem
with moving their shoulder in a
certain plane or direction.
So, what we ask the patient to do
is to do three different steps.
First, we ask them to reach
across their chest
over their shoulder and try to
touch their opposite scapula.
Then we ask them to reach
behind their back
and touch the
Then they reach behind their
head and try to touch
the scapula on the opposite
side of the arm.
As you're doing these
you're comparing the motion
and mobility on both sides
and how far can they reach
in terms of touching the scapula.
A positive test would be if they're unable
to reach equal levels on each side.
in adhesive capsulitis:
One of the techniques that
we could potentially use
to treat patients with adhesive
capsulitis is muscle energy.
Muscle energy technique could be applied to
a wide range of issues and complaints.
But what we could do here is to try to
restore the muscle’s normal length
and remove any
restrictions in motions.
How we perform muscle energy
is that we localize the joint
and we want to try to engage
the muscle that is spasmed.
We have to take that joint and put it
into its barrier of motion in all planes.
Let's say my shoulder is
restricted in abduction.
The physician will place the shoulder
first into the joint barrier.
Then we're going to ask the
patient to move that joint
towards its relative
So, if my barrier was abduction,
my freedom would be adduction.
So then, I would contract
my muscles isometrically,
meaning that my joint doesn't
move for three to five seconds.
After that, the patient relaxes and then
you should be able to move that joint
a little bit further into
its new barrier.
Then you repeat the steps
three to five times.
This is using the
Golgi tendon reflex.
It pretty much almost like
exhausts the muscle
so that you could stretch the
muscle a little bit further.
At the end, you want to add
a little bit of a passive stretch
in order to increase the
range of motion at that joint.
Another technique that could be used for
adhesive capsulitis is Spencer's technique.
This is an articulatory technique to increase
range of motion of the shoulder.
I remember that articulatory techniques
are techniques that just repetitively
take the joint gently
into the barrier.
So, what we're going to do is we're going to
gently spring the joint into the barrier
similar to where you
would put the joint to
when you're putting somebody into the barrier
for muscle energy technique.
In fact, you could actually add
muscle energy technique
to the end of each of these motions
to help enhance this technique.
So, adhesive capsulitis has a restriction
of motion of the shoulder joint.
Spencer’s technique, what it does
is really moves the joint
into every possible
plane of motion
to try to increase the range of motion
of the shoulder joint.
The motions include extension, flexion,
circumduction, circumduction with traction,
abduction, internal rotation,
and then glenohumeral traction.
What you're going to do is you're going to gently
engage the barrier of motion each time
for seven times. Then you're going to perform
this technique in this sequence.
So usually, you could utilize Spencer's
technique for any sort of issue
with the shoulder where
there's a restriction of motion.
Not only adhesive capsulitis but you could
also treat it and use this technique
to treat any other issues going
around the glenohumeral joints.
It actually will help treat issues with the
rib cage, the clavicle, and thoracic spine
because of the muscles that attach
through the shoulder joint also.