Australian Papers - Shoulder Impingement Part 1

Shoulder pain – impingement.

I have discussed before the standard of anatomy education in Australia; not that the standards are poor by comparison with other countries, the curriculum has, of necessity, been amended to provide space for more modern and more appropriate, topics. Pain is often managed by injections of anaelgesics, and difficult joints are often replaced by artificial ones. Basic education, such as the study and understanding of joint function has been compressed, even by-passed, to allow the inclusion of these other matters.

This is not a criticism of modern education; it is intended to be a reminder to any person involved in the manual therapy profession that your skills are needed more than ever – you, very likely, understand more about musculo-skeletal discomforts than your medical practitioner – only because he/she has moved on towards what is considered as more relevant stages.

The point I am trying to emphasise is, less time is spent on the study of joint function. I’m not just expressing a private opinion here; discussions with acquaintances in the medical profession have supported my thesis that seemingly simple topics, (such as today’s shoulder performance), have been swept aside by the arrival of new data and discoveries. 

The first photo below shows the shoulder of a client who arrived at my clinic this week; she had been examined by her medical practitioner, because she experienced pain in in the upper arm, together with limited, and uncomfortable abduction. There is still residual bruising from a cortico-steroid injection into the gleno-humeral capsule, as this discomfort was considered a rotator cuff injury.

These other images show the remaining views of the affected, as well as the unaffected, sides.

Abduction was difficult to perform, and limited to about 30 degrees. To those of us who have no experience with such an event this appears somewhat trivial, but to the client, simple tasks such as dressing, undressing, and all overhead activities – putting things on shelves, combing hair – are challenging. Add to this list the threat of future surgery, and you have a major event.

This woman, after three brief treatments, is well on the way to a full recovery. I need to stop here, to reassure the readers that this is not an exercise in self-praise. Many of you understand the basics of gleno-humeral function better than I, and are already falling asleep.

To the remaining few, may I say read on, because I want to take you through the few clinical steps in the correction of this common, and mis-understood, ailment that sits in the category of frozen shoulder, or shoulder impingement. More next week, possums – here’s a snapshot from my home town – on a clear day, mind you.

BERNARD SCULLY
NEWCASTLE, AUSTRALIA, AUGUST 2011