The Shoulder

Impingement Syndrome

This primarily involves the impingement of the rotator cuff, subacromial bursa, and/or the bicep tendon by the boney coracoacromial arch. Typical symptoms experienced with impingement are:

  • Pain on the outer aspect of the upper arm, possibly extending below the elbow.
  • Sharp twinges felt on various movements, such as putting on your jacket or reaching above shoulder level.
  • It is usually a gradual onset with no known injury to the shoulder.


Typical treatment for impingement syndrome involves the use of ultrasound, friction massage, instruction on appropriate use of the arm, and a re-strengthening program.


Shoulder instability can be caused by general weakness of the muscles surrounding the shoulder joint (the rotator cuff) or damage to the internal and/or external joint structures (joint capsule, ligaments, and/or labrum).

Patients who have instability due to general weakness will complain of discomfort brought on by certain arm positions or activities.

Patients who have experienced a significant injury causing damage to the shoulder structures often describe a feeling of the shoulder ?slipping out of the joint? momentarily but going back into place spontaneously. Apprehension of certain arm positions is a common feature as well.


The strength of the rotator cuff muscles is the single most important consideration in managing shoulder instability. Strengthening exercises of the rotator cuff and scapular stabilizing muscles are critical to optimal recovery and will be the focus of rehabilitation.

Adhesive Capsulitis (Frozen Shoulder)

What is involved in the condition is tightening of the joint capsule which surrounds the shoulder joint. This results in restricted, painful movement which often interferes with daily activities and may interrupt sleep.

Symptoms patients often complain of are:

  • Pain on the outside of their upper arm, possible extending down below the elbow.
  • Pain experienced varies from a constant dull ache to pain felt only on activities involving movement in the restricted ranges.
  • Being awakened at night when rolling onto the painful shoulder.
  • Very gradual onset of pain, possibly related to minor injury, immobilization, chest surgery, or myocardial infarction.


Ice/heat and gentle joint mobilization, active assisted range of motion exercises, a strengthening exercise program, posture re-training if needed as well as ultrasound and more aggressive joint mobilization as the condition improves.